chapter 2: theoretical perspective on direct practice

Chapter 2:Chapter 2: Theoretical Theoretical Perspective Perspective on Direct on Direct PracticePractice

An OverviewAn Overview

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Copyright © Allyn & Bacon 2006

Direct PracticeDirect Practice

Unrealistic to teach all models (250+) Unrealistic to teach all models (250+) so will present select models to assist so will present select models to assist in creating a knowledge base for each in creating a knowledge base for each student.student.

Focus is on using deductive models from Focus is on using deductive models from a broad prospective moving toward a broad prospective moving toward specific theories, models and specific theories, models and techniques.techniques.2


Direct Practice Skills Direct Practice Skills

► Know how to develop & maintain Know how to develop & maintain professional helping relationshipsprofessional helping relationships

► Collect & assess information about the Collect & assess information about the problem/situationproblem/situation

► Recognize the client’s strengths and abilitiesRecognize the client’s strengths and abilities

► Develop a plan to improve the Develop a plan to improve the problem/situationproblem/situation

► Use proven research interventionsUse proven research interventions

► Work within NASW values & ethicsWork within NASW values & ethics3


Direct Practice EffectivenessDirect Practice Effectiveness►Average client 80% better than those Average client 80% better than those

not treated at the end of treatment not treated at the end of treatment (Smith et.al. 1980)(Smith et.al. 1980)

►Average client showed 75% Average client showed 75% improvement after 6 months of weekly improvement after 6 months of weekly psychotherapy (Howard, et.al. 1986)psychotherapy (Howard, et.al. 1986)

►Medical model grew out of Freudian Medical model grew out of Freudian theory of psychodynamicstheory of psychodynamics

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Common Elements of Common Elements of Effective PracticeEffective Practice

► General areas of improvement include extra General areas of improvement include extra therapeutic change, therapeutic relationship, therapeutic change, therapeutic relationship, techniques, and expectancy-placebo effect (Asay & techniques, and expectancy-placebo effect (Asay & Lambert 1999)Lambert 1999)

► Findings suggest therapy is a viable treatment for Findings suggest therapy is a viable treatment for psychological disorderspsychological disorders

► Theories, models, and techniques do not differ Theories, models, and techniques do not differ significantly in terms of positive outcomessignificantly in terms of positive outcomes

► For some disorders specific techniques produce For some disorders specific techniques produce better outcomesbetter outcomes

► Long-term therapy is not necessary to produce Long-term therapy is not necessary to produce improvementimprovement 5


Theories & ModelsTheories & Models► A theory is “a group of related hypotheses, A theory is “a group of related hypotheses,

concepts, and constructs, based on facts and concepts, and constructs, based on facts and observations, that attempts to explain a observations, that attempts to explain a particular phenomenon (Baker 1999)particular phenomenon (Baker 1999)

► Theories are then conceptualized as models Theories are then conceptualized as models which are mapped out representations of which are mapped out representations of relationships, concepts, and constructsrelationships, concepts, and constructs

► Professional “joins” with the client by Professional “joins” with the client by applying theoretical knowledge,assessing applying theoretical knowledge,assessing biopsychosocial-cultural conditions, and biopsychosocial-cultural conditions, and client’s strengths and resources to client’s strengths and resources to ameliorate the identified problemameliorate the identified problem

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Five Domains for Five Domains for Understanding Human Understanding Human

BehaviorBehavior►Biological/physiologicalBiological/physiological

►PsychologicalPsychological

►Emotional Emotional

►BehavioralBehavioral

►EnvironmentalEnvironmental

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Domain Selection based on Domain Selection based on influencesinfluences

►The time practitioner received educationThe time practitioner received education

►Practitioners personality, values, and Practitioners personality, values, and sense of which models match personal sense of which models match personal style and belief systemstyle and belief system

► Influence of a mentor or significant Influence of a mentor or significant personperson

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An Integrative ModelAn Integrative Model

►Practitioner learns a variety of theories Practitioner learns a variety of theories and techniques for assessment, and techniques for assessment, implementation and interventionsimplementation and interventions

►EclecticismEclecticism

►Selective borrowingSelective borrowing

►Specifically designed integrative modelsSpecifically designed integrative models

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Strengths vs. Problem Strengths vs. Problem PerspectivesPerspectives

► Medical model referred to as problem, Medical model referred to as problem, disease or deficit model (uses diagnostic disease or deficit model (uses diagnostic code often DSM to identify problem)code often DSM to identify problem)

► Social Work profession has moved toward a Social Work profession has moved toward a strengths oriented focusstrengths oriented focus

► Everything you do as a social worker will be Everything you do as a social worker will be predicated in some way on helping discover predicated in some way on helping discover and embellish, explore and exploit clients’ and embellish, explore and exploit clients’ strengths and resources” (Saleebey, 2002)strengths and resources” (Saleebey, 2002)

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Biological-Genetic/Biological-Genetic/Neurological Theory Neurological Theory

►Personality and psychological Personality and psychological disordersdisorders

►Temperament & traitsTemperament & traits

►Activity level, sociability, & Activity level, sociability, & emotionalityemotionality

►Family history (e.g. alcoholism)Family history (e.g. alcoholism)

►Neurochemistry Neurochemistry 11


Ego PsychologyEgo Psychology

► Emphasis on sociocultural factors, interpersonal Emphasis on sociocultural factors, interpersonal relationships, and psycho-social development through relationships, and psycho-social development through lifelife

► Object relations emphasis on caretaker relationship Object relations emphasis on caretaker relationship early in lifeearly in life

► Self psychology focus on how people view self and Self psychology focus on how people view self and parentsparents

► Energy derived from desire to adapt to objective Energy derived from desire to adapt to objective external realityexternal reality

► Built on belief that people learn how to cope with, Built on belief that people learn how to cope with, adapt to and shape the world around themadapt to and shape the world around them

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Ego Psych (cont’d)Ego Psych (cont’d)► Important biopsychosocial factors are heredity and Important biopsychosocial factors are heredity and

environmental impactenvironmental impact

► Ego development requires mastery of Ego development requires mastery of developmental tasks sequentiallydevelopmental tasks sequentially

► Ego is autonomous and relates to internal drives Ego is autonomous and relates to internal drives and needsand needs

► Ego mediates internal conflicts & drives, Ego mediates internal conflicts & drives, environment & personenvironment & person

► Personality is shaped by social environmentPersonality is shaped by social environment

► Problems with social functioning require the Problems with social functioning require the evaluation of individual’s environmental resources evaluation of individual’s environmental resources and conditions (Goldstein 1995)and conditions (Goldstein 1995)

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Cognitive TherapyCognitive Therapy► Cognition is knowing through insight and Cognition is knowing through insight and

understanding experienceunderstanding experience

► Knowing through “cognitive maps” which Knowing through “cognitive maps” which organize & learn (Tolman & Honzik 1930)organize & learn (Tolman & Honzik 1930)

► People take in information, process it, and People take in information, process it, and then develop a planthen develop a plan

► Incorrect processing comes from arbitrary Incorrect processing comes from arbitrary inference, selective abstraction, inference, selective abstraction, overgeneralization, minimalization, overgeneralization, minimalization, personalization, and absolutistic, personalization, and absolutistic, dichotomous thinkingdichotomous thinking

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Behavioral TherapyBehavioral Therapy

► Focus on exhibited maladaptive behaviorFocus on exhibited maladaptive behavior

► Classical conditioningClassical conditioning

► Operant conditioningOperant conditioning

► Social Learning includes behavior, Social Learning includes behavior, environmental influences and reciprocal environmental influences and reciprocal determinism (Ewen 2003)determinism (Ewen 2003)

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Person Centered TheoryPerson Centered Theory► Individual basically sound, whole, healthy, Individual basically sound, whole, healthy,

and unique with an innate drive for growth and unique with an innate drive for growth and self-actualization (Maslow 1968)and self-actualization (Maslow 1968)

► Each person’s experience is unique and Each person’s experience is unique and subjectivesubjective

► Emphasize relationship between client and Emphasize relationship between client and therapisttherapist

► Focus toward self-fulfillment, self-Focus toward self-fulfillment, self-actualization and wholenessactualization and wholeness

► Treatment depends on client insightTreatment depends on client insight

► Emphasis on free will and choiceEmphasis on free will and choice18


General System TheoryGeneral System Theory► Focus on the whole including behavior and societies Focus on the whole including behavior and societies

interacting between systems with controls to stabilize and interacting between systems with controls to stabilize and maintain a state of equilibrium (Baker 1999)maintain a state of equilibrium (Baker 1999)

► A system includes the “whole” and all related parts and A system includes the “whole” and all related parts and processesprocesses

► Issues include boundaries, subsystems, roles and maintaining Issues include boundaries, subsystems, roles and maintaining homeostasishomeostasis

► Inputs and outputs provide positive and negative feedbackInputs and outputs provide positive and negative feedback

► Interface happens at the point two or more systems intersectInterface happens at the point two or more systems intersect

► Differentiation, entropy and negative entropy identify how Differentiation, entropy and negative entropy identify how system moves from simple to complexsystem moves from simple to complex

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Multicultural TheoryMulticultural Theory►Worldviews are the reservoirs for our Worldviews are the reservoirs for our

attitudes, values, opinions and concepts attitudes, values, opinions and concepts and influence how we think, make and influence how we think, make decisions, behave and define events (Sue decisions, behave and define events (Sue et.al. 1996)et.al. 1996)

►Worldviews are influenced by cultureWorldviews are influenced by culture

►Practitioner must be aware of client Practitioner must be aware of client culture to ensure supportive servicesculture to ensure supportive services

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Multicultural Counseling Multicultural Counseling Therapy (MCT) (Sue et.al. Therapy (MCT) (Sue et.al.

1996)1996)► Therapy is tied to culture and beliefsTherapy is tied to culture and beliefs

► Counseling theory automatically favors that Counseling theory automatically favors that cultureculture

► Practitioners worldview influences how client’s Practitioners worldview influences how client’s concern is definedconcern is defined

► MCT incorporates and combines elementsMCT incorporates and combines elements

► MCT attempts to assist clients in generating new MCT attempts to assist clients in generating new ways of feeling, thinking and actingways of feeling, thinking and acting

► MCT is a theory of predicting failure from MCT is a theory of predicting failure from overemphasizing cultural differences or similaritiesoveremphasizing cultural differences or similarities

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MCT (con’t)MCT (con’t)► All people have multiple levels of identityAll people have multiple levels of identity

► Identity is influenced by person’s contextIdentity is influenced by person’s context

► Client’s will notice similarities and Client’s will notice similarities and differences with social worker & uniquenessdifferences with social worker & uniqueness

► Client concerns usually include cultureClient concerns usually include culture

► Social worker has own worldviewSocial worker has own worldview

► Social worker must be skilled and Social worker must be skilled and knowledgeable to be able to track the clientknowledgeable to be able to track the client

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MCT (con’t) MCT (con’t)

►Both client and practitioner experience Both client and practitioner experience a cultural identitya cultural identity

►Developmental processes and cultural Developmental processes and cultural identity influence one’s self identityidentity influence one’s self identity

►Goal setting is likely to be influenced Goal setting is likely to be influenced by cultural development and identityby cultural development and identity

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Counseling Culturally Counseling Culturally DifferentDifferent

► Cognitive, emotional and behavioral aspects of an Cognitive, emotional and behavioral aspects of an individual follow a sequenceindividual follow a sequence

► Each client has multiple cultural identitiesEach client has multiple cultural identities

► MCT may help client’s recognize cultural issuesMCT may help client’s recognize cultural issues

► Important to see self-concept as “conception of Important to see self-concept as “conception of self-in-relation”self-in-relation”

► Social worker must be aware of power Social worker must be aware of power differential’differential’

► Social worker must continually strive to increase Social worker must continually strive to increase awarenessawareness

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Cultural Difference (con’t)Cultural Difference (con’t)► Acknowledge the contextual factors of Acknowledge the contextual factors of

cultural developmentcultural development

► Behavior must be assessed through cultural Behavior must be assessed through cultural contextcontext

► Identity is complexIdentity is complex

► Disagreement is often differenceDisagreement is often difference

► Need to be flexibleNeed to be flexible

► Cultural difference is not equal to individual Cultural difference is not equal to individual differencedifference

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Cultural Difference (con’t)Cultural Difference (con’t)

► Intentional and unintentional racism are Intentional and unintentional racism are harmfulharmful

► Culturally sensitive approaches include Culturally sensitive approaches include universal and culturally specificuniversal and culturally specific

► Use a cultural frame of referenceUse a cultural frame of reference► Counseling and psychotherapy are based on Counseling and psychotherapy are based on

languagelanguage► Client and counselor matching should be the Client and counselor matching should be the

client’s domainclient’s domain► Social workers need a variety of skills including Social workers need a variety of skills including

empathy and appropriate responseempathy and appropriate response

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Cultural Difference (con’t)Cultural Difference (con’t)►Help is best when the social worker Help is best when the social worker

can apply numerous roles (therapist, can apply numerous roles (therapist, broker, mediator, case manager, broker, mediator, case manager, advocate) across micro, mezzo and advocate) across micro, mezzo and macro levelsmacro levels

►Network with othersNetwork with others

►Be open and flexibleBe open and flexible

►View counseling in broad terms using View counseling in broad terms using title based on client positive title based on client positive connotationconnotation 27


Cultural Difference (con’t)Cultural Difference (con’t)

► Values and ethics may need to be reframed Values and ethics may need to be reframed to be culturally sensitiveto be culturally sensitive

► Each client occurs in a cultural contextEach client occurs in a cultural context

► Successful outcomes based on individual-in-Successful outcomes based on individual-in-context modelcontext model

► Multicultural assessment perspectives Multicultural assessment perspectives increases accuracyincreases accuracy

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chapter 2: theoretical perspective on direct practice

Documents

deductive models

specific theories

exploit clients strengths

direct practice skills

direct practice unrealistic

theories modelsa theory

disorders specific techniques

variety of theories