Case study

Salman Wahid

SWK313Module2Week3_Theories_Powerpoint2019.pptx

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Engaging with individuals and families

SWK 313 Module 2

Week 3

Part 2

Our journey includes…

Psychodynamic Approaches

Task Centred

Crisis Intervention

Cognitive Behavioural Practice

Humanistic, existential approaches and spirituality

Strengths, narrative & solution practice

Systems & Ecological Approaches

Community Development

Critical perspectives

Feminist perspectives

Anti-Oppressive & Anti-Discriminatory Practice

Empowerment and Advocacy

Psychodynamic Approaches

Psychodynamic approaches

Still inform practice today (particularly psychiatric settings)

Dominant in 1920s-60s

Basis of ‘traditional’ social work practice with individuals and families

Foundation for psychology

Attachment theory sits within this perspective and informs a range of fields including child care and education

Forms a basis for ecological systems theory

Informs client-centred practice approaches

Many different strands and forms of this theory in use

Theories of human development, personality, abnormal psychology and treatment

General practice issues and concepts

Assumes behaviour comes from within people’s minds – psychological focus, individual focus

General personality theory concepts – id, ego, superego

Anxiety results from conflict between the id vs ego/superego and managed through defense mechanisms (projection, splitting, rationalisation, sublimation)

Treatment theory concepts - transference and counter transference

Intervention traditionally focuses on talk-therapies and giving people insight into repressed feelings

Critical analysis

Cannot be tested in a conventional scientific positivist way

Cultural and social assumptions stemming from the original work of Freud and his first clients (white, middle-class, European)

Can reinforce stereotypes of women (patriarchal foundations)

Medical model of treatment

Practitioner directed (‘expert’)

Insight does not always lead to change

Overly focused on the past

Assumes the early experiences are the most significant in shaping current behaviour and circumstances

Long term therapy – cost, effectiveness, dependency?

Jargon

Clients – verbal communication skills

Environmental, social & structural factors have less prominence

Task-Centred Practice

Task-centered Practice

Reid & Epstein (1972) Task-Centred Casework

Based on research which showed short term, planned interventions are effective (and as effective as long term)

Individual reformist tradition

1960s & 1970s – changing context of practice - need to streamline, make interventions ‘brief’, accountable

Most commonly used brief intervention (along with Crisis Intervention and CBT)

Grew from and challenged psychodynamic approaches, and crisis intervention

Can be used in diverse practice contexts including involuntary settings, family work and group work

Partnership approach consistent with principles of Anti-Oppressive Practice

General practice issues and concepts

Practical tasks to resolve particular problems

Responds to client priorities

Tasks are agreed on by client and worker

Focused on outcomes

Structured, clear, directive, pragmatic, brief

Brings together skills and resources of both client and worker

Can incorporate other stakeholders (e.g. services) into shared objectives (case management)

Steps & process…

Explore problems

Focus problems

Refine goals

Agreement established (contract)

Develop & agree on tasks

Carry out tasks

Review tasks

End & evaluate

Task Centred Casework (UK resource)

http://content.iriss.org.uk/taskcentered/index.html

Critical analysis

Not effective where there is constant crisis and long term psychological problems

Assumes client can actively engage as equals - motivation, capacity and resources?

Not suitable in some contexts requiring full social control or authoritarian protection

False sense of equality (contracts)

Informed by medical model

Problem focused

Does not address underlying causes or issues (surface approach)

Formal stage structure – some may need a more personal approach to therapy and time to build rapport, flexibility

Does not address poverty and social inequality

Crisis Intervention

1940s-60s: Erich Lindemann & Gerald Caplan

Developed from preventative psychiatry, draws on ego psychology

Crisis can be an opportunity for change

Intervention is generally focused on immediate needs and concerns for safety – focus on here and now, recent events

Strong emotional reactions are dealt with then practice builds on strengths to aid recovery and equilibrium

Equilibrium model (Caplan 1965); Cognitive model (Roberts 1995); Psychosocial transition model (Erikson 1965)

General practice issues and concepts

Can be completed in one contact if needed

Adapts to different levels of crisis

Adapts to different events & circumstances (e.g. disaster, critical incident, casework)

Adapted to different timeframes for intervention

Effective for working with diverse populations, however worker needs to be culturally competent

Broadened concept of crisis and application of theory to other practice contexts (e.g. families)

Crisis can be developmental or situational

Reaction to crisis varies between individuals

Draws on research and theories regarding reaction to crisis and stress, including:

Stages of crisis (outcry, denial/intrusiveness, working through, resolution – resemble stages of grief)

Intervention

Aim – provide support and assistance during the crisis

Focus on specific time-limited goals to reduce tension

Clarify and assess source of stress and its meaning

Develop adaptive problem-solving skills and coping mechanisms

Reality oriented, provide emotional support

Use existing helping relationships and networks for support

Explore further treatment/support needs

Roberts (2000) 7 Stage Model

Conduct crisis assessment

Establish rapport

Identify major problems

Deal with feelings and emotions

Generate and explore alternatives

Develop and formulate an action plan

Establish a follow up plan and agreement

Critical analysis

Important workers also integrate cultural competence when working with this model – is a stage model appropriate in all cases?

Crisis vs. stress (ongoing)

Differing interpretations and definition of crisis

Medical orientation – limited definition of crisis to mental health/health concerns

Risks of crisis intervention – use in Critical Incident Debriefing (CID)

Address underlying structural dimensions of crisis?

Cognitive Behavioural Practice

http:// www.therapistaid.com /therapy-worksheet/simple- cbt -model

Cognitive Behavioral Practice

Range of counselling techniques derived from social learning theory (Bandura 1977), behavioural psychology & cognitive theory

Use of CBT (developed by Aaron Beck) in social work practice grew in 1980s

Supported by research

Used by a number of disciplines

Motivational Interviewing – increase client receptiveness to change

Cognitive restructuring e.g. Rational Emotive Behaviour Therapy (Ellis)

Mindfulness techniques – Acceptance and Commitment Therapy (ACT)

General practice concepts and issues

Understand how client behaviours can be triggered and maintained or extinguished (classical & operant conditioning)

Reactions to an event (behaviour or cognitions) may not helpful/appropriate

CBT methods focus on changing thoughts and feelings to change behaviour

Involves collaboration with the client to start with a clear assessment and measures of progress and outcomes (scale)

Challenge cognitive distortions or “irrational beliefs” – our perceptions and interpretations of the event influence our behaviour

Develop skills that can be learnt through therapy and then transferred to real life situations (generalisation)

Practitioners can integrate humanistic ideas, social constructionism – beliefs and meaning-making

Interventions

Self monitoring - activity charts, mood tracking

Scheduling activities – events/activities to elevate mood

Interpersonal skills training (e.g. communication skills, assertiveness training)

Arousal reduction skills – manage anxiety, stress, anger (e.g. mindfulness, controlled breathing)

Reduce avoidance – e.g. exposure (imagery, in vivo)

Safety behaviours – distraction, exposure practice in safe spaces, positive self-talk

Identify automatic thoughts, images, memories, beliefs (e.g. thought records, focused questions by therapist)

Evaluate core beliefs using evidence (cost benefit analysis),

Develop skills in shifting perspective and challenging unhelpful core beliefs and cognitive processes

Practical tools and resources for CBT

http://www.therapistaid.com/therapy-worksheets/none/ none

https://moodgym.anu.edu.au/ welcome

https://ecouch.anu.edu.au/ welcome

http://www.psychology.org.au/Events/EventView.aspx?EventID= 14601

Critical analysis

EBP critiques - positivist, Western scientific methods

Specialised method of practice

Not suitable for all social work practice or all contexts (requires a supportive therapeutic environment)

Evaluation of effectiveness – some mental health conditions

Overly focused on individual problems/deficits in cognition – what about strengths?

Does not address structural factors

Ignores context and environmental factors

Oversimplified model focusing on behaviour-mind relationship – can this be tested?

Technical and structured approach – flexible enough?

Can change be maintained over long periods of time?

Humanism, Existentialism, Spirituality

http://socialworkpodcast.blogspot.com.au/2007/02/bio-psychosocial-spiritual-bpss.html

http://jspp.psychopen.eu/article/view/126/html

Leonardo da Vinci’s

Vitruvian Man (c.1490)

Humanism, Existentialism and Spirituality

Carl Rogers – humanistic psychology & person-centred therapy

Concerned with the integrity of the human experience and its personal social purposes and meaning

Humanistic practice – values human reasoning, ‘rational knowledge’, focused on human rights and based on philosophy

Spirituality is important in understanding human nature, social and personal needs

Holistic approach to assessment and intervention – includes bio-psycho-social-cultural-spiritual dimensions (mind, body, spirit)

Culturally and spiritually diverse perspectives

Practice Issues and concepts

Empathy, congruence, genuineness and unconditional positive regard provides the basis for effective client-worker therapeutic relationship – supported by evidence

Self actualization and potential (Maslow’s hierarchy of needs 1970)

Draws on art, philosophy and spirituality

Rejects technical, bureaucratic practice

Views the person holistically

Does not generally fit in formal domains of practice

Allows for creativity, flexibility and openness to different views and values

Aligned with social work values and human rights perspectives

Can be integrated with a range of other theories e.g. feminist, green social work, mindfulness, ecological systems theory.

Critical analysis

Very broad – does not provide specific guidance for practice

Respond effectively to Western practice contexts and welfare systems?

Evidence base?

Combination of inconsistent perspectives or values?

Does not seek to achieve social change or address structural factors

Western orientation – still focuses on the individual

Open to workers imposing their own values, beliefs and philosophies on clients

References

Connolly, M. (2007). Practice frameworks: Conceptual maps to guide interventions in child welfare. British Journal of Social Work, 37(5), 825-837.

Howe, D.(2009) A Brief Introduction to Social Work Theory UK: Palgrave MacMillan

Maidment, J., & Egan, R. (2009). Practice skills in social work and welfare: More than just common sense. Allen & Unwin.

Payne,M.(2014)Modern Social Work Theory. (4rd ed.) UK: Palgrave MacMillan

The Cognitive Model

Situation something happens

Thought

the situation is interpreted

Emotion

a feeling occurs as a result of the thought

Behavior

an action in response to the emotion

http://www.therapistaid.com/