1. Clinical Social Work and Use of Practice Theories plus Models
SOW6425 Clinical Assessment and Intervention Planning
Professor Nan Van Den Bergh, PhD, LCSW

2. Definition of Practice Theory
A coherent set of ideas about human nature, including concepts of :
Health and illness
Normalcy and deviance
The nature of change
Practice theory provides:
verifiable or established explanations for behavior
rationales for intervention.

3. Types of Theories Case theories: explain behavior of one client
What is your “theory” about the causes of a client's behavior?
Mid-range theories: explain a set of behaviors
Explanation as to why unemployed males can demonstrate domestic violence
Grand theories: explain human development, as well as “causes” and “cures” for maladaptive states, which can be generalized across populations
Freud’s theory of psychosexual development
Erickson’s “developmental crises” theory of human development
Piaget’s theory of cognitive development

4. Practice Theory Functions
Simplifying complex phenomena into a focus on client’s thoughts, feelings and behaviors
Identifying our knowledge gaps about clinical situations
Explaining and predicting client cognitions and behavior
Bringing order to the selection of intervention targets and strategies
Bolstering professional self-discipline by protecting against irrational procedures
Promoting generalization among clients by cumulative practice knowledge
Mobilizing social energy to coordinate the work of other service providers
Enhancing our status within our agencies and among our peers

5. Benefits of Theory Theory Focuses Attention
When the social worker “knows” what to do, assessment and intervention
activities make better use of time and other therapeutic resources
Commitment to a body of thought “greater than oneself” bolsters
professional self-discipline.
In “naive eclecticism” our choices for intervention might emerge outside of
awareness and be influenced by irrational factors
Theory Protects the Client
The worker can maintain a healthy distance from the client.
Without a theoretical base, “clinical skepticism may be subverted in the
service of empathy”.

6. Challenges of Using Theory
There is a potential harm of rigidly adhering to any practice theory.
Since theories simplify complex human behavior, they:
Are reductionist
Can be anti-humanistic
Create self-fulfilling prophecies by biasing perceptions of the client
Blind us to alternative understandings of behavior.

7. THE RELATIONSHIP OF THEORY TO PRACTICE
“Primary” Practice Theory (for Assessment)
(Fits the practitioner’s assumptions about human nature)
Practice Model
(( A guiding strategies for working with certain types of clients)
Practice Strategies
(A guiding strategy for approaching a specific client)
Interventions
(The implementation of practice strategies; what we actually do
to facilitate the change process)

8. Relationship Between Theory and Intervention Strategies
Not every theory has unique intervention strategies
i.e. relaxation exercises or mindfulness practices could be use by both a behaviorist as well as an ego psychologist
Ego psychologist may see psychodynamics at root of addiction; but, use behavioral methods for changing self-destructive behavior

9. Theory and Practitioner’s “Practice Model”
Practice model: guiding strategy for working with certain types of clients
i.e. Begin with behavioral techniques to extinguish destructive and encourage constructive behavior
Then, undertake reflective interventions for insight development (person-situation reflection)
Practice Strategy is the individualization of a practice model” to a specific client’s personal and environmental characteristics
One client may be receptive to mindfulness practices whereas another is not

10. Curative Factors in All Practice Interventions
Perception of practitioner, by client, as competent and caring
Therapeutic alliance
“Special setting” of seeking therapy promotes client’s sense of safety and expectation of help
Interventions and procedures are based on an rationale which is understandable(to the client), and theyn include an optimistic view of human nature.
Practitioner is “congruent” with client’s perception of problem and world view
Practitioner’s ongoing attention too client’s frame of reference
Client is given new opportunities for enhancing mastery

11. Curative Factors in Practice (cont.)
Miller, Duncan and Hubble (2005):
Client characteristics associated with clinical outcome (account for 40% of outcome):
Nature of the problem
Motivation
Participation
Quality of therapeutic alliance (30%)
Guiding theory or model (15%)
Placebo effect (15%)

12. Curative Factors in Practice (cont.)
Carkoff and Truax: Predictors to client retention in treatment:
Empathy
Congruence
Genuineness

13. Practitioner’s Reasons for Theory Selection (both rational and irrational factors)
The theory’s research support
Belief that theory produces positive results (with the least expenditure of time and money)
It’s provision of useful intervention techniques
It’s consistent with practitioner's values, knowledge, skills and worldview
Personal habit
It’s use by co-workers or supervisor/s

14. Selecting a Theory for Practice
A good theory for practice should be:
Coherent (internally consistent)
Useful with the practitioner's current clients
Comprehensive (applicable across a range of clients)
Parsimonious (uncomplicated to use)
Testable and able to withstand scrutiny (there are a variety of methods for doing this

15. CLINICAL PRACTICE THEORIES
Focus on Reflection/Insight: Psychodynamic Theories
Ego Psychology (for individuals and groups)
Object Relations (for individuals and groups)
Self Psychology (for individuals and groups)
Family Emotional Systems: Bowen (can be applied to individuals and couples as well as families)

16. CLINICAL PRACTICE THEORIES (cont.)
Focus on Conscious Thought / Observable Behavior
Cognitive Theory (for individuals and groups)
Behavioral Theory ((for individuals and groups)
Structural Family Theory: Minuchin

17. CLINICAL PRACTICE THEORIES (cont.)
Focus on Relationship:
Relational Theory and Cultural Relational Theory
Interpersonal Therapy (a model)
Feminist Therapy (a model)
Afrocentric Therapy (a model)

18. CLINICAL PRACTICE THEORIES (cont.)
Models and “Newer” Theories:
Crisis Theory and Intervention
Solution–focused therapy
Narrative Theory and Therapy
Motivational Interviewing