LCSW Exam Section 3: Psychotherapy, Clinical Interventions, and Case Management

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; more interested in creating change in behavior than change in understanding Concepts/Techniques -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 and 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

Psychodrama

A treatment approach in which roles are enacted in a group context. Members of the group recreate their problems and devote themselves to the role dilemmas of each member

Flooding

A treatment procedure in which a client's anxiety is extinguished by prolonged real or imagined exposure to high-intensity feared stimuli

Stages of Group Development

1. Preaffiliation: development of trust (known as forming) 2. Power and Control: struggles for individual autonomy and group identification (known as Storming) 3. Intimacy: utilizing self in service of the group (known as Norming) 4. Differentiation: acceptance of each other as distinct individuals (known as Performing) 5. Separation/termination: independence (known as Adjourning)

Countertransference

Defined as redirection of a social worker's feelings toward a client, or more generally, as a social worker's emotional entanglement with a client

Throughput

Energy that is integrated into the system so that it can be used by the system to accomplish its goals

Adoption Assistance and Child Welfare Act of 1980

Focuses on family preservation efforts to help keep families together and children out of foster care or other out-of-home placements.

Indian Child Welfare Act of 1978

Gives American Indian/Native American/Indigenous nations or organizations jurisdiction over child welfare cases that involve an American Indian/Native American/Indigenous child in order to protect the integrity of these families

Methods of Conflict Resolution

1. The recognition of an existing or potential conflict 2. An assessment of the conflict situation 3. The selection of an appropriate strategy 4. Intervention

To work effectively with families (i.e. family life education), a social worker must....

1. Understand the develop of, as well as the historical, conceptual, and contextual issues influencing, family functioning 2. Have awareness of the impact of diversity in working with families, particularly race, class, culture, ethnicity, gender, sexual preference, aging, and disabilities 3. 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 4. Be aware of the needs of families experiencing unique family problems (domestic violence, blended families, trauma and loss, adoptive families, etc.)

Congruence

Matching of awareness and experience with communication (verbal and nonverbal); congruence is essential for the vitality of a relationship and to facilitate true helping as part of the problem-solving process

Respondent or classical conditioning paradigm

Pavlov Learning occurs as a result of pairing a previously neutral (conditioned) stimulus with an unconditioned (involuntary) stimulus so that the conditioned stimulus eventually elicits the response normally elicited by the unconditioned stimulus Unconditioned stimulus ----> Unconditioned Response Unconditioned stimulus + conditioned stimulus----> Unconditioned response Conditioned stimulus----> conditioned response

Child Abuse Prevention and Treatment Act of 1974

Provides federal funding to states in support of prevention, assessment, investigation, prosecution, and treatment activities; also provides grants to public agencies and nonprofit organizations for demonstration programs and projects

Health Insurance Portability and Accountability Act (HIPAA) of 1996

Provides individuals with access to their medical records and more control over how their personal health information is used and disclosed

Workforce Innovation and Opportunity Act of 2014 (WIOA)

Reauthorized Workforce Investment Act of 1998 with several key changes in areas such as Workforce Development Boards structure; One-Stop Operations; Job-Driven Training for Adults and Dislocated Workers; and Integrated Performance and Youth Services

Transference

Refers to redirection of a client's feelings for a significant person to a social worker (i.e. attraction, rage, parentification, extreme dependence, etc.)

Family systems theory

Searches for the causes of behavior, not in the individual alone, but in the interactions among the members of a group. The basic rationale is that all part of the family are interrelated. Further, the family has properties of its own that can be known only by looking at the relationships and interactions among all members

Homeostasis

Steady state

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

Social role theory

Terms that relate to role issues: -Role ambiguity: lack of clarity of role -Role complementarity: the role is carried out in an expected way (i.e. parent-child, social worker-client) -Role discomplementarity: the role expectations of others differs from one's own -Role reversal: when two or more individuals switch roles -Role conflict: incompatible or conflicting expectations

Primary Prevention

The goal is to protect people from developing a disease, experiencing an injury, or engaging in a behavior in the first place -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 nutrition -Counseling about the dangers of tobacco and other drugs *Most cost effective prevention strategy*

Token economy

A client receives tokens are reinforcement for performing specified behaviors. The tokens function as currency within the environment and can be exchanged for desired goods, services, or privileges

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, as an emotional system complete with its own multigenerational transmission, chronic anxiety, emotional triangles, cutoffs, projection processes, and fusion and differentiation struggles

Methods for working with involuntary clients

-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 as involuntary clients struggle to understand what is happening to them -Making clear what the purpose of the intervention is, what client 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 an appropriate pace as progress may be slow -Building trust, even on the smallest scale, by consistently being honest and upfront 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 service

Verbal and nonverbal communication techniques

-Active listening -Silence -Questioning (open and closed ended) -Reflecting or validating -Paraphrasing and clarifying -Reframing -Exhibiting desirable facial expression (eye contact, warmth and concern, etc.) -Using desirable postures and gestures (matching client, etc.)

Couples interventions and treatment approaches

-Behavior modification -Insight-oriented psychotherapy -The Gottman Method

Motivation techniques

-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

Methods to enhance strengths

-Collaboration and partnership between a social worker and client -Creating opportunities for learning or displaying competencies -Environmental modification--environment is both a resource and a target of intervention

Basic assumptions of Family Systems Theory

-Each family is more than a sum of its members -Each family is unique due to the infinite variations in personal characteristics and cultural and ideological styles -A healthy family has flexibility, consistent structure, and effective exchange of information -The family is an interactional system whose components parts have constantly shifting boundaries and varying degrees of resistance to change -Families must fulfill a variety of functions for each member, both collectively and individually, if each member is to grow and develop -Families strive for a sense of balance or homeostasis Negative feedback loops are those patterns of interaction that maintain stability or constancy while minimizing change. Negative feedback loops help to maintain homeostasis. Positive feedback loops, in contrast, are patterns of interaction that facilitate change or movement toward either growth or dissolution -Families are seen as being goal-oriented, The concept of equifinality refers to the ability of the family system to accomplish the same goals through different routes -The concept of hierarchies describes how families organize themselves into various smaller units or subsystems that together comprise the larger family system. When the members or tasks associated with each subsystem become blurred with those of other subsystems, families are viewed as having difficulties. For example, when a child becomes involved in marital issues, difficulties often emerge that require intervention -Boundaries occur at every level of the system and between subsystems. Boundaries influence the movement of people and the flow of information into and out of the system. Some families have very open boundaries where members and others are allowed to freely come and go without much restriction, whereas in other families, there are tight restrictions on where family members can go, and who may be brought into the family system. Boundaries occur at every level of the system and between subsystems. Boundaries influence the movement of people and the flow of information into and out of the system. Some families have very open boundaries where members and others are allowed to freely come and go without much restriction, whereas in other families, there are tight restrictions on where family members can go, and who may be brought into the family system. Boundaries also regulate the flow of information in a family. In more closed families, the rules strictly regulate what information may be discussed and with whom. In contrast, information may flow more freely in families that have more permeable boundaries. -The concept on interdependence is critical in the study of family systems. Individual family systems. Individual family members and the subssystems that compromise the family system are mutually influenced by, and are mutually dependent upon, one another. What happens to one family member, or what one family member does, influences other family members

Empowerment Strategies in Interventions

-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 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

Empathic Communication

-Establishes rapport with clients-empathic communication is one means of bridging the gap between a social worker and a client -Starts where a client is and stays attuned to a client throughout the encounter (being perceptive to changes in frame of mind) -Increases the level at which clients explore themselves and their problems -Responds to a client's nonverbal messages (a social worker can observe body language and make explicit a client's feelings) -Decreases defensiveness and engages a client in processing and testing new information -Defuses anger that represents obstacles to progress

Key clinical issues in family therapy 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 the influence of family history on current family interactions -Ascertaining communication patterns -Identifying family rules that regulate patterns of interaction -Determining the meaning of the 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

Things to assess in taking family history

-Ethnic backgrounds (including immigration) and traditions -Biological ties (adoption, blended family structures, foster children) -Occupations and educational levels -Unusual life events or achievements -Psychological and social histories, as well as current well-being -Past and present substance use behaviors -Relationships with other family members -Roles within the immediate and larger family unit -Losses such as those from death, divorce, or physical separation -Current and past significant problems, including those due to medical, financial, and other issues -Values related to economic status, educational attainment, and employment -Coping skills and defense mechanisms

Factors affecting group cohesion include....

-Group size -Homogeneity (similarity of group members) -Participation in goal and norm setting for group -Interdependence (dependent on one another for achievement of common goals) -Member stability (frequent change in memberships results in less cohesiveness)

Types of groups

-Groups centered on a shared problem -Counseling groups -Activity groups -Action groups -Self-help groups -Natural groups -Closed versus open groups -Structured groups -Crisis groups -Reference groups (similar values)

Standard elements of a case presentation

-Identifying data (demographics, cultural considerations) -History of the presenting problem (family history) -Significant medical/psychiatric history (diagnoses) -Significant personal and/or social history (legal issues, academic/work problems, crisis/safety concerns) -Presenting problem (assessment, mental status, diagnosis) -Impressions and summary (interview findings) -Recommendations (treatment plan/intervention strategies, goals, theoretical models used)

Benefits of peer supervision

-Increased access/frequency of supervision -Reciprocal learning through the sharing of experiences -Increased skills and responsibility for self-assessment -Decreased dependency on expert supervisors

Groups help through.....

-Instillation of hope -Universality -Altruism -Interpersonal learning -Self-understanding and insight

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 readily be 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 his or her respective goals

Operant techniques

-Positive reinforcement: Increases probability that behavior will occur--praising, giving tokens, or otherwise rewarding positive behavior -Negative reinforcement: behavior increases because a negative (aversive) stimulus is removed (i.e. remove shock) -Positive punishment: presentation of an undesirable stimulus following a behavior for the purpose of decreasing or eliminating that behavior (i.e. hitting, shocking) -Negative punishment: removal of a desirable stimulus following a behavior for the purpose of decreasing or eliminating that behavior (i.e. removing something positive, such as token or dessert)

Roles in Healthy Families

-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

Techniques for Anger Management

-Relaxation exercises -Deep breathing; meditation or repeating calming words/phrases; guided imagery; yoga; stretching or physical exercise -Cognitive Techniques -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 balances perspective; not using an "all or nothing" approach; putting situations into perspective -Communication skills -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 -Environmental change -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

Roles in Dysfunctional Families

-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: 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

Areas included in a social work appraisal or evaluation (of a social worker)

-The ability to establish and maintain meaningful, effective, appropriately professional relationships with clients -Knowledge and skills (i.e. data-gathering, diagnostic, treatment/intervention, interviewing, and recording skills) -Ability to adhere to agency objective, policies, and procedures -Use of supervision -Staff and community relationships -Professional attributes and attitudes, including adherence to the Code of Ethics -Cultural competence

Basic conditions for therapeutic process

-There must be trust with a social worker -Recognition that therapeutic process is a joint exploration -There must be listening on both sides -Accepting what is said in a nonjudgmental manner

Common Self-Motivating techniques

-Visualizing his or her goals, including using visual images on the refrigerator or in a place that will remind a client of the desired aim -Reminding himself or herself of why change is needed -Making up a contract with himself or herself of steps that will be taken toward reaching the desired end result -Rewarding himself or herself when progress is made on the goals -Taking a break to do something that is liked or be with a friend to stay encouraged -Being around positive people who will encourage and not create barriers to change -Educating himself or herself about steps that will assist in the change effort -Breaking down goals into achievable steps -Forgiving himself or herself when setbacks in progress occur -Conceptualizing a new reality or what life will be like when change happens

Four things are critical in consulation

1. Defining the purpose of the consultation 2. Specifying the consultant's role 3. Clarifying the nature of the problem 4. Outlining the consultation process

Steps in Cognitive Restructuring

1. Accepting that their self-statements, assumptions, and beliefs determine or govern their emotional reaction to life's events 2. Identifying dysfunctional beliefs and patterns of thoughts that underlie their problems 3. Identifying situations that evoke dysfunctional cognitions 4. Substituting functional self-statements in place of self-defeating thoughts 5. Rewarding themselves for successful coping efforts

Five case management activities

1. Assessing 2. Planning 3. Linking 4. Monitoring 5. Advocacy

Steps for Referring Clients to Services

1. Clarifying the need or purpose for the referral 2. Researching resources 3. Discussing and selecting options with client 4. Planning for the initial contact 5. Initial contact between client and referral source 6. Follow-up to see if need was met

Techniques to structure interactions between conflicted parties

1. Decreasing the amount of contact between the parties in the early stages of conflict resolution 2. Decreasing the amount of time between problem-solving sessions 3. Decreasing the formality of problem-solving sessions 4. Limiting the scope of the issues that can be discussed 5. Using a third party mediator

Phases/Steps of Intervention/Treatment

1. Engagement with client, group, or community 2. Assessments of strengths and needs 3. Planning or design of intervention 4. Intervention aimed at making change 5. Evaluation of efforts 6. Termination and anticipation of future needs

Drisko's five key factors necessary for a quality therapeutic relationship....

1. affective attunement 2. mutual affirmation 3. joint efforts to resolve missteps 4. goal congruence 5. using varying types of empathy

Principles for obtaining and providing feedback

1. Feedback may be either verbal or nonverbal, so social workers must take efforts to see what clients are trying to convey verbally via their behavior and nonverbal cues in order to see whether interventions should be altered 2. When social workers involve consultants or others in the feedback process related to client care, clients should provide consent 3. Social workers should ask for feedback in difficult circumstances-not just when circumstances appear neutral or positive. It can be tempting to only ask for feedback from people who will say something positive. Sometimes the best learning can be from those who will be critical. Talking through difficult feedback in supervision is important. 4. Feedback is especially critical at key decision points (as when transferring or closing cases) 5. It is important to guard against influencing people to respond in a particular way-this may be unintentional because a social worker may have more influence or power than the individual from whom feedback is sought 6. Confidentiality should be respected if the informant wants it 7. Always be clear about why feedback is needed and what will be done with the information 8. Documentation of feedback is essential 9. Be aware that the feedback may be very different depending upon when it is solicited. It is critical to realize how recent events may have influenced information received. Getting feedback repeatedly at several different times may be needed to see if responses differ 10. A social worker must make sure that the communication method is appropriate. For a younger person, texting, email, or an online questionnaire may work, whereas face-to-face conversation may be needed for others. The language should be jargon-free and issues such as language, culture, and disability may affect that ways in which people both understand and react to requests for feedback. A social worker may want to use closed-ended questions and/or open ones to capture needed data

Sibling position

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

Important elements of behavioral objectives

1. Good behavioral objectives are client-oriented and place the emphasis upon what a client will need to do in order for change to occur 2. Good behavioral objectives are clear and understandable and contain a clearly stated verb that describes a definite action or behavior 3. Good behavioral objectives are observable and describe an action that results in observable products 4. 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

Open system

A system with cross boundary exchange

Pyschodynamic approaches

Aim to help clients review emotions, thoughts, early life experiences, and beliefs in order to gain insight into their lives and present-day problems

Strength

Any ability that helps an individual client (or family) confront and deal with a stressful life situation and to use the challenging situation as a stimulus for growth *Strengths vary from one situation to another and are contextual*

Differentiation

Becomes specialized in structure and function

Rational emotive therapy (RET)

A cognitively oriented therapy in which a social worker seeks to change a client's irrational beliefs by argument, persuasion, and rational reevaluation and by teaching a client to counter self-defeating thinking with new, nondistressing self-statements

Genogram

A graphic representation of a family tree that displays the interaction of generations within a family; goes beyond a traditional family tree by allowing social worker and client to analyze family, emotional, and social relationships

Subsystem

A major component of a system made up of two or more interacting and interdependent components that interact in order to attain their own purpose(s) and the purpose(s) of the system in which they are embedded

Group Work

A method of social work that helps individuals to enhance their social functioning through purposeful group experiences, as well as cope more effectively with their personal, group, or community problems. In group work, individuals help each other in order to influence and change personal, group, organizational, and community problems

Task-centered approach

Aims to quickly engage clients in the problem-solving process and to maximize their responsibility for treatment outcome; 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; "here and now" focus; no assessment phase

Psychotherapy

Aims to treat clients with mental disorders or problems by helping them understand their illness or situation; use verbal techniques to teach clients strategies to deal with stress, unhealthy thoughts, and dysfunctional behaviors; helps clients manage their symptoms better and function optimally in everyday life

Systematic desensitization

An anxiety-inhibiting response cannot occur at the same time as the anxiety response. Anxiety-producing stimulus is paired with relaxation-producing response so that eventually anxiety-producing stimulus produces a relaxation response. At each step, a client's reaction of fear or dread is overcome by pleasant feelings engendered as the new behavior is reinforced by receiving a reward. The reward could be a compliment, a gift, or relaxation

Permanency Planning

An approach to child welfare that is based on the belief that children need permanence to thrive Primary goal is to get children back into their original homes through investigation and making environment safer and more enriching; if that's not possible, then services move towards getting children into a permanent and safe environment as quickly as possible

Suprasystem

An entity that is served a number of component systems organized in interacting relationships

Harm reduction approach

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

Aversion therapy

Any treatment aimed at reducing the attractiveness of a stimulus or a behavior by repeated pairing of it with an aversive stimulus. An example of this is treating alcoholism with Antabuse.

Meso (mezzo) level of intervention

Apply to larger groups or communities; attempt to make connections between micro and macro levels

Equifinality

Arriving at the same end from different beginnings

Operant conditioning

B.F. Skinner Antecedent events or stimuli precede behaviors, which, in turn, are followed by consequences. Consequences that increase the occurrence of the behavior are referred to as reinforcing consequences; consequences that decrease the occurrence of the behavior are referred to as punishing consequences. Reinforcement aims to increase behavior frequency, whereas punishment aims to decrease it. Antecedent--->Response/Behavior->Consequence

Learning Theory- Social/situational

Bandura Learning is obtained between clients and their environment and interactions or observations in social contexts. Social workers establish opportunities where conversation and participation can occur.

Problem-solving model

Based on the belief that an inability to cope with a problem is due to some lack of motivation, capacity, or opportunity to solve problems in an appropriate way. Goal of this approach is to enhance the client's mental, emotional, and action capacities for coping with problems and/or making accessible the opportunities and resources necessary to generate solutions to problems. 1. Engaging 2. Assessing 3. Planning 4. Intervening 5. Evaluating 6. Terminating

Biofeedback

Behavior training program that teaches a person how to control certain functions such as heart rate, blood pressure, temperature, and muscular tension. Biofeedback is often used for ADHD and panic/anxiety disorders.

Biopsychosocial-spiritual-culutral model

Biological dimension refers to the role of biological systems within the body (i.e. genetic predispositions) and outside (i.e. airborne pathogens that impact functioning) Psychological dimension refers to the role of thoughts, emotion, and behavior on an individual, group, or community functioning. Inclusion of this dimension also acknowledges the mind-body connection in the assessment of problems Social dimension refers to how a client relates to various groups and institutions in society, as well as how groups and institutions relate to him or her. Social workers assist not only individual clients, but all others who might be similarly affected by an issue. Spiritual dimension refers to the role of religious or spiritual belief on well-being Cultural dimension acknowledges the importance of considering customs, rituals, values, and communications that may be part of a client's cultural heritage

Cognitive behavioral therapy (CBT)

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 these relate to behavior, as a way of dealing with emotional problems. This is 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

Americans with Disabilities Act (ADA) of 1990

Civil rights legislation that prohibits discrimination on the basis of disability; also requires covered employers to provide reasonable accommodations to employees with disabilities and imposes accessibility requirements on public accommodations; includes both mental and physical disabilities

Entropy

Close, disorganized, stagnant; using up available energy

Micro level of intervention

Concentrate on helping individual clients solve their problems; access needed services from other agencies; provide direct support and counseling; can include individuals, couples, and/or families

Differentiation (Bowenian family therapy)

Core concept of 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

Crisis Intervention/Treatment Approaches

Crisis intervention is a process of actively influencing the psychosocial functioning of clients during a period of disequalibrium or crisis; "acute" stage of crisis can last variable length depending on several factors Goals are: 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

Partialization

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; aims to break complex issues into simpler ones

Negative entropy

Exchange of energy and resources between systems that promote growth and transformation

Patient Protection and Affordable Care Act of 2010 (ACA)

Expands access to insurance, increases protections, emphasizes prevention and wellness, improves quality and system performance, expands the health workforce, and curbs rising health care costs

Gestalt theory and terms

Focus is on awareness and change -Retroflection: treating onself as one actually wants to treat other persons or objects (i.e. wanting to get mad at a co-worker but instead getting mad at oneself for being a coward and not doing it) -Introjection: to do as others want one to do (should, ought to thoughts) -Projection: when a person acts toward others what he accuse them of acting to him -Confluence: does not know who is doing what to whom because the boundaries between self and others are too vague

Bowenian Family Therapy

Focuses on improving the intergenerational transmission process; assumed that improvement in overall functioning will ultimately reduce a family member's symptomatology Eight major theoretical constructs are differentiation, emotional fusion, multigenerational transmission, emotional triangle, nuclear family, family projection process, sibling position, and societal regression

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. -Pain management groups -Rehabilitation groups -Support groups

Education for Handicapped Children Act of 1975

Guarantees a free, appropriate public education to all children with disabilities between the ages of 3 and 21; children need to have IEPs (goals, means of attaining goals, and ways of evaluating goal attainment); other services like speech therapy are provided at no extra cost to family

Violence Against Women Act (VAWA) of 1994

Improved criminal justice response to violence against women by strengthening federal penalties for repeat sex offenders and creating a federal "rape shield law," which is intended to prevent offenders from using victims' past sexual conduct against them during a rape trial; keeping victims safe by requiring that a victim's protection order will be recognized and enforced in all state, tribal, and territorial sentencing of offenders by helping communities develop dedicated law enforcement and prosecution units and domestic violence dockets; training law enforcement officers, prosecutors, victim advocates, and judges; and ensuring access to the services needed by victims to achieve safety and rebuild their lives

Termination

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)

Systems theory

Includes biopsychosocial-spiritual-cultural dimensions and state they're interrelated and work together; when one dimension changes within a system, the whole system or client's well-being is affected

Learning Theory- Humanistic

Maslow Learning is viewed as a client's activities aimed to fulfill his/her potential and the locus of learning is to meet cognitive and other needs. Social workers aim to develop the whole person.

One-on-One Feedback

Method for feedback An individual delivering feedback to another, face-to-face, is probably the most common form. Such feedback needs to be delivered sensitively and according to principles of the profession

Consultative Feedback

Method for feedback An individual or group serves as a formal or informal consultant to another (usually to a group, but occasionally to an individual). The individual or group receiving the feedback may be more apt to accept and consider the feedback, given the expertise of the consultative entity, but has no obligation to do so

Intragroup Feedback

Method for feedback Individuals in a group provide feedback to the group and/or to one or more individuals within the group. If the feedback is directed to the performance of the group, it can be particularly effective

360-Degree Feedback

Method for feedback It involves feedback from all directions-supervisors, peers, subordinates, the community, and so forth. The idea is that the feedback reflects multiple viewpoints and gives a complete picture

Group-to-Group Feedback

Method for feedback This might take place between two groups that are working together. The feedback may go in one direction or both. The feedback might be directed at particular individuals or at the group as a whole

Modeling

Method of instruction that involves an individual (the model) demonstrating the behavior to be acquired by a client

Shaping

Method used to train a new behavior by prompting and reinforcing successive approximations of the desired behavior

Patient Self-Determination Act (PSDA) of 1991

New set of federal requirements intended to implement advance directive policies at all health care facilities that receive federal funding through Medicaid and Medicare programs. The Act specified that these facilities must inform clients of their rights to make decisions concerning their own health care, ask and document whether a client has an advance directive, and provide education for staff and the community Advance directives are a legal way of indicating that a person has given the legal rights to a designated person to make decisions on his or her behalf about continuation of support measures should the individual be incapable physically or mentally of making his or her wants known; paired with living wills

Secondary Prevention

Occurs after a disease, injury, or illness has occurred. It aims to slow the progession or limit the long-term impacts. It is often implemented when asymptomatic, but risk factors are present. Can also focus on preventing re-injury -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

Group polarization

Occurs during group decision making when decisions strengthen a dominant point of view and results in a shift to a more extreme position than any of the members would adopt on their own

The Older Americans Act (OAA) of 1965

Offers services to older Americans through establishment of Administration on Aging that distributes federal funding to states to provide services for adults over age 60

In vivo desensitization

Pairing and movement through anxiety hierarchy from least to most anxiety-provoking situation; takes place in "real" setting

Learning Theory- Behaviorist

Pavlov, Skinner Learning is viewed through change in behavior and the stimuli in the external environment are the locus of learning. Social workers aim to change the external environment in order to bring about desired change

Approaches used in working with traumatized clients

Phase 1: Safety and Stabilization Focused on establishing safety and stability through meeting basic needs, case management, and/or crisis intervention (safety planning, etc.) Phase 2: Mourning and Remembrance When survivors acknowledge and speak about what happened and are ready to integrate experiences into a larger life context; allows emotional space in which the future can be constructed; addressing grief and loss Phase 3: Reconnection and Reintegration Marked by a commitment to move forward in life, searching for ways to use the trauma experience for empowerment; moves from surviving into a new identity marked by an understanding of his/her history of trauma. Therapeutic strategies include integration of self-care strategies into everyday life and developing deepening resilience

Learning Theory- Cognitive

Piaget Learning is viewed through internal mental processes (including insight, information processing, memory, and perception) and the locus of learning is internal cognitive structures. Social workers aim to develop opportunities to foster capacity and skills to learn better

Output

Product of the system that exports to the environment

Multiethnic Placement Act of 1994 (MEPA)

Prohibits agencies from refusing or delaying foster or adoptive placements because of a child's or foster/adoptive parent's race, color, or national origin. It also prohibits agencies from considering race, color, or national origin as a basis for denying approval as a foster and/or adoptive parent

Family Educational Rights and Privacy Act (FERPA) of 1974

Protects privacy of educational records in institutions that receive funds under an applicable program of the Unites States Department of Education; parents can access records until child turns 18

Time out

Removal of something desirable- negative punishment technique

Family and Medical Leave Act (FMLA) of 1993

Requires covered employees to provide up to 12 weeks of unpaid, job-protected leave to "eligible" employees for certain family and medical reasons, with continuation of group health insurance coverage under the same terms and conditions as if he employee had not taken leave

Two Fundamental Classes of Behavior

Respondent: involuntary behavior (anxiety, sexual response) that is automatically elicited by certain behavior. A stimulus elicits a response 2. Operant: voluntary behavior (walking, talking) that is controlled by its consequences in the environment

Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA)

Shifted both the method and goal of federal cash assistance to the poor; added workforce development component to welfare legislation to encourage poor to work; created Temporary Assistance for Needy Families (TANF) and put a 5 year limit on receipt of benefits

Title VI of the Civil Rights Act of 1964

States that no person shall "on the grounds of race, color, or national origin, be excluded from participation in, denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance"

Stress management

Step 1: Clients monitor their stress levels and identify their stress triggers (large or small events) Step 2: Assist clients in identifying what aspects of a situation they can control (can make these changes themselves or implement stress-reduction techniques

Macro level of intervention

Stresses the importance of economic, historical, sociopolitical, and environmental influences on client well-being and functioning; macro interventions can include creating or changing policies, procedures, regulations, and laws; aimed at not only assisting individual clients, but others who are experiencing the same difficulties

Structural Family Therapy

Stresses the importance of family organization for the functioning of the group and the well-being of its members. 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: 1. Interpersonal boundaries define individual family members and promote their differentiation and autonomous, yet interdependent, functioning. Dysfunctional families tend to be characterized by either of a pattern of rigid enmeshment or disengagement 2. 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 3. Hierarchical organization in families of all cultures is maintained by generational boundaries, the rules differentiating parent and child roles, and rights and obligations Restructuring is based on observing and manipulating interactions within therapy session, often by enactments of situations as a way to understand and diagnose the structure and provide an opportunity for restructuring

Behavioral approaches

Suggest that personality is a result of interaction between the individual and the environment; represents the systematic application of principles of learning to the analysis and treatment of behaviors

Emotional fusion

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

The nuclear family

The most basic unit in society and there is a concern over the degree to which emotional fusion can occur in a family system. When forming relationships outside of the nuclear family, clients tend to pick mates with the same level of differentiation

Emotional triangle

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

Evaluation

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

Input

To attain the goals of the system, it must obtain the resources from environment that are necessary

Closed system

Uses up its energy and dies

Groupthink

When a group makes faulty decisions because of group pressures Eight causes of groupthink: 1. Illusion of vulnerability (creates excessive optimism that encourages taking extremes) 2. Collective rationalization (members discount warnings and do not reconsider their assumptions) 3. Belief in inherent morality (members believe in the rightness of their cause and ignore the ethical or moral consequences of their decisions) 4. Stereotyped views of those "on the out" (negative views of the "enemy" make conflict seem unnecessary) 5. Direct pressure on dissenters (members are under pressure not to express arguments against any of the group's views) 6. Self-censorship (doubts and deviations from the perceived group consensus are not expressed) 7. Illusion of unanimity (the majority view and judgments are assumed to be unanimous) 8. Self-appointed "mindguards" (the members protect the group and the leader from information that is problematic or contradictory to the group's cohesiveness, view, and/or decisions

Extinction

Withholding a reinforcer that normally follows a behavior. Behavior that fails to produce reinforcement will eventually cease.

The core of the helping process is....

acceptance of a client and the use of objective feedback