Chapter 2: Theoretical Perspective on Direct Practice An Overview 1

Copyright © Allyn & Bacon 2006 Direct Practice Unrealistic to teach all models (250+) so will present select models to assist in creating a knowledge base for each student. 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 Five Domains for Understanding Human Behavior ► Biological/physiological ► Psychological ► Emotional ► Behavioral ► Environmental 7

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 An Integrative Model ► Practitioner learns a variety of theories and techniques for assessment, implementation and interventions ► Eclecticism ► Selective borrowing ► Specifically designed integrative models 9

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 Biological-Genetic/Neurological Theory ► Personality and psychological disorders ► Temperament & traits ► Activity level, sociability, & emotionality ► Family history (e.g. alcoholism) ► Neurochemistry 11

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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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Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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

Copyright © Allyn & Bacon 2006 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