Chapter 2: Theoretical Perspective on Direct Practice

1. Chapter 2:Theoretical Perspective on Direct Practice An Overview 1

2. Direct Practice Unrealistic to teach all models (250+) so will present select models to assist in creating a knowledge base for each student. Focus is on using deductive models from a broad prospective moving toward specific theories, models and techniques. 2

3. Direct Practice Skills • Know how to develop & maintain professional helping relationships • Collect & assess information about the problem/situation • Recognize the client’s strengths and abilities • Develop a plan to improve the problem/situation • Use proven research interventions • Work within NASW values & ethics 3

4. Direct Practice Effectiveness • Average client 80% better than those not treated at the end of treatment (Smith et.al. 1980) • Average client showed 75% improvement after 6 months of weekly psychotherapy (Howard, et.al. 1986) • Medical model grew out of Freudian theory of psychodynamics 4

5. Common Elements of Effective Practice • General areas of improvement include extra therapeutic change, therapeutic relationship, techniques, and expectancy-placebo effect (Asay & Lambert 1999) • Findings suggest therapy is a viable treatment for psychological disorders • Theories, models, and techniques do not differ significantly in terms of positive outcomes • For some disorders specific techniques produce better outcomes • Long-term therapy is not necessary to produce improvement 5

6. Theories & Models • A theory is “a group of related hypotheses, concepts, and constructs, based on facts and observations, that attempts to explain a particular phenomenon (Baker 1999) • Theories are then conceptualized as models which are mapped out representations of relationships, concepts, and constructs • Professional “joins” with the client by applying theoretical knowledge,assessing biopsychosocial-cultural conditions, and client’s strengths and resources to ameliorate the identified problem 6

7. Five Domains for Understanding Human Behavior • Biological/physiological • Psychological • Emotional • Behavioral • Environmental 7

8. Domain Selection based on influences • The time practitioner received education • Practitioners personality, values, and sense of which models match personal style and belief system • Influence of a mentor or significant person 8

9. An Integrative Model • Practitioner learns a variety of theories and techniques for assessment, implementation and interventions • Eclecticism • Selective borrowing • Specifically designed integrative models 9

10. Strengths vs. Problem Perspectives • Medical model referred to as problem, disease or deficit model (uses diagnostic code often DSM to identify problem) • Social Work profession has moved toward a strengths oriented focus • Everything you do as a social worker will be predicated in some way on helping discover and embellish, explore and exploit clients’ strengths and resources” (Saleebey, 2002) 10

11. Biological-Genetic/Neurological Theory • Personality and psychological disorders • Temperament & traits • Activity level, sociability, & emotionality • Family history (e.g. alcoholism) • Neurochemistry 11

12. Ego Psychology • Emphasis on sociocultural factors, interpersonal relationships, and psycho-social development through life • Object relations emphasis on caretaker relationship early in life • Self psychology focus on how people view self and parents • Energy derived from desire to adapt to objective external reality • Built on belief that people learn how to cope with, adapt to and shape the world around them 12

13. Ego Psych (cont’d) • Important biopsychosocial factors are heredity and environmental impact • Ego development requires mastery of developmental tasks sequentially • Ego is autonomous and relates to internal drives and needs • Ego mediates internal conflicts & drives, environment & person • Personality is shaped by social environment • Problems with social functioning require the evaluation of individual’s environmental resources and conditions (Goldstein 1995) 13

14. Cognitive Therapy • Cognition is knowing through insight and understanding experience • Knowing through “cognitive maps” which organize & learn (Tolman & Honzik 1930) • People take in information, process it, and then develop a plan • Incorrect processing comes from arbitrary inference, selective abstraction, overgeneralization, minimalization, personalization, and absolutistic, dichotomous thinking 14

15. Behavioral Therapy • Focus on exhibited maladaptive behavior • Classical conditioning • Operant conditioning • Social Learning includes behavior, environmental influences and reciprocal determinism (Ewen 2003) 15

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18. Person Centered Theory • Individual basically sound, whole, healthy, and unique with an innate drive for growth and self-actualization (Maslow 1968) • Each person’s experience is unique and subjective • Emphasize relationship between client and therapist • Focus toward self-fulfillment, self-actualization and wholeness • Treatment depends on client insight • Emphasis on free will and choice 18

19. General System Theory • Focus on the whole including behavior and societies interacting between systems with controls to stabilize and maintain a state of equilibrium (Baker 1999) • A system includes the “whole” and all related parts and processes • Issues include boundaries, subsystems, roles and maintaining homeostasis • Inputs and outputs provide positive and negative feedback • Interface happens at the point two or more systems intersect • Differentiation, entropy and negative entropy identify how system moves from simple to complex 19

20. Multicultural Theory • Worldviews are the reservoirs for our attitudes, values, opinions and concepts and influence how we think, make decisions, behave and define events (Sue et.al. 1996) • Worldviews are influenced by culture • Practitioner must be aware of client culture to ensure supportive services 20

21. Multicultural Counseling Therapy (MCT) (Sue et.al. 1996) • Therapy is tied to culture and beliefs • Counseling theory automatically favors that culture • Practitioners worldview influences how client’s concern is defined • MCT incorporates and combines elements • MCT attempts to assist clients in generating new ways of feeling, thinking and acting • MCT is a theory of predicting failure from overemphasizing cultural differences or similarities 21

22. MCT (con’t) • All people have multiple levels of identity • Identity is influenced by person’s context • Client’s will notice similarities and differences with social worker & uniqueness • Client concerns usually include culture • Social worker has own worldview • Social worker must be skilled and knowledgeable to be able to track the client 22

23. MCT (con’t) • Both client and practitioner experience a cultural identity • Developmental processes and cultural identity influence one’s self identity • Goal setting is likely to be influenced by cultural development and identity 23

24. Counseling Culturally Different • Cognitive, emotional and behavioral aspects of an individual follow a sequence • Each client has multiple cultural identities • MCT may help client’s recognize cultural issues • Important to see self-concept as “conception of self-in-relation” • Social worker must be aware of power differential’ • Social worker must continually strive to increase awareness 24

25. Cultural Difference (con’t) • Acknowledge the contextual factors of cultural development • Behavior must be assessed through cultural context • Identity is complex • Disagreement is often difference • Need to be flexible • Cultural difference is not equal to individual difference 25

26. Cultural Difference (con’t) • Intentional and unintentional racism are harmful • Culturally sensitive approaches include universal and culturally specific • Use a cultural frame of reference • Counseling and psychotherapy are based on language • Client and counselor matching should be the client’s domain • Social workers need a variety of skills including empathy and appropriate response 26

27. Cultural Difference (con’t) • Help is best when the social worker can apply numerous roles (therapist, broker, mediator, case manager, advocate) across micro, mezzo and macro levels • Network with others • Be open and flexible • View counseling in broad terms using title based on client positive connotation 27

28. Cultural Difference (con’t) • Values and ethics may need to be reframed to be culturally sensitive • Each client occurs in a cultural context • Successful outcomes based on individual-in-context model • Multicultural assessment perspectives increases accuracy 28