1. PSYCHODYNAMIC THEORIES: Ego Psychology SOW6425 Assessment and Planning Nan Van Den Bergh, PhD, LCSW

2. Overview of Psychodynamic Theories All psychodynamic theories emphasize: –Stages of psychosocial (psychosexual) development –Impact of unconscious mental processes on human behavior Early psychodynamic theories describe mind as composed of three components: –Id: innate drives seeking pleasure aggression,when wellbeing is threatened –Ego: adapts drives to socially acceptable outlets –Superego: conscience or internalized value system

3. Areas of Focus Within Most Psychodynamic Perspectives DRIVES –Pleasure –Aggression –Relationship –Mastery and competence

4. Areas of Focus Within Most Psychodynamic Perspectives (cont.) Unconscious motivational and emotional processes Conflict among opposing needs ( internal needs vs. external constraints; internal impulses vs. impulsive controls= id vs. superego) Defenses as coping mechanisms Attachment and relationship experiences as potent factors in personality development (NOTE: Ego psychology is attuned to these issues but does not necessarily act on them all; the practitioner can stay in the present, and focus on the person’s conscious life.)

5. Ego Psychology Perspectives GO Ego psychology emerged from psychoanalysis in the 1930’s Its development was related to: Need for a psychology of normal development Humanistic ideas of adaptive capacities rather than pathology Through ego psychology social work shifted its thinking: away from the role of the unconscious toward an emphasis on strengths, adaptability and the role of the social environment

6. Ego Psychology Perspectives (cont.) People are born with an ego ( a natural capacity to adapt to the environment) that develops throughout the lifetime Your “ego” is your conception of “who you are:” It is the “you” that thinks, feels, and acts in a reasonably consistent manner The ego helps you to reflect, plan, and act in ways so that you can “fit in” (more or less adequately) with your social environment BUT - there are unconscious elements of the ego The ego is that part of an individual’s mind that negotiates between her/his basic needs and the demands of the environment. Negotiates between internal needs and demands of social living

7. Ego Psychology as a Psychodynamic Theory Cognition occurs in ego, but unconscious mental processes can influence conscious thinking Defense (or coping) mechanisms are unconscious processes that arise as a way to manage conflicts

8. Ego Psychology as a Psychodynamic Theory (cont.) Ego psychology recognizes original drives of pleasure and aggression but adds two more: –Mastery: ability to influence one’s environment –Competence: Subjective feelings about one’s ability to master environment Drives toward pleasure and aggression bring people in conflict with social norms –Drives need to be channeled appropriately and thus may be frustrated at times –Frustration creates anxiety; hence neuroses/”complexes”.

9. Ego Psychology as a Psychodynamic Theory (cont.) Drives toward mastery and competence are considered conflict free They evolve from an innate desire to exist harmoniously within one’s environment Mastery and competence evolve from: –talents –accomplishing developmental tasks –seeking and experiencing affirming interpersonal connections –achieving personal goals

10. Major Concepts of Ego Psychology People are born with an innate capacity to adapt to their environment –Capacity develops over time through learning and psychosocial maturation Social influences on psychological functioning are significant and many of these are transmitted through the family unit Problems in social functioning can occur at any state of development due to person-environment and internal conflicts

11. EGO PSYCHOLOGY Conscious Awareness _____________________________________________ Unconscious mental processes The Ego

12. Significance of Emotional Life Psychodynamic theories recognize the importance of emotional life in its conscious and unconscious aspects Some conscious thinking is a product of the drives, from which emotions also spring Humans are pleasure seekers and “feelers by nature –Thoughts are our means of deciding how to gratify the drives Defense mechanisms result from the need to indirectly manage drives when we become frustrated: – when impulses need to be channeled into acceptable behaviors

13. Significance of Emotional Life (cont.) People need to explore thoughts and feelings to understand their essential drives Capacity for change is facilitated by uncovering ideas and accompanying feelings that are kept out of consciousness –When people understand their impulses they can be directed toward appropriate sources of gratification –Therefore, emotions as feeling states have specific survival value

14. Significance of Emotional Life (cont.) Magi (1996) : Emotional traits form the core of human personality: All people possess five emotions: Happiness, sadness, fear, anger, interest/excitement Emotions are “hard wired,” originating within one’s neurophysiology Personalities are organized around those affective “biases” Emotions are instinctual and sources of motivation They can activate behavior in ways that are adaptive When emotions are activated they have a pervasive influence on cognition and behavior Thus, emotions can influence cognition

15. Significance of Emotional Life (cont.) Mead (1934), originator of symbolic interaction theory: Emotions develop as symbols for communication Emotional expressions are particularly powerful since they are received visually rather than verbally Hence, they are cross culturally understood Focusing on emotional experience helps clients to become more aware of how they express themselves and perceive others Individuals may deny, distort, avoid, or repress an emotion, and thus be unable to constructively manage a person-environment challenge If emotions do not achieve their adaptive function in our relationships, problems in social functioning may occur

16. Significance of Emotional Life (cont.) Problems associated with emotions: Emotional experiences may be poorly regulated (either minimized or not controlled). If emotions do not enhance our interaction with the social environment, problems in social functioning may occur Social or occupational impairments

17. MAJOR EGO FUNCTIONS (and questions to consider in their assessment) Reality Testing: Awareness and accurate perception of the external environment, one’s internal world and of the differences between them. Is the client oriented to time, place, and person? Is there evidence of a thought disorder (hallucinations, delusions, loose associations)? Judgment: The capacity to identify possible courses of action and to anticipate and weigh the consequences of behavior so as to engage in appropriate action. Critical for effective problem solving When making decisions, can the client choose behaviors that are likely to promote good adjustment and movement toward goals? Does the quality of the client’s judgment vary in different circumstances?

18. MAJOR EGO FUNCTIONS (cont.) Sense of Identity: Coherent physical and psychological sense of self. Ability to be aware of the world and one’s connection to it as real, to experience one’s own body as intact, to feel a sense of self and to experience boundaries between oneself and others –Does the client experience dissociation or separateness from oneself? –Does the client have a reasonably coherent physical and psychological sense of self? –Does the client maintain appropriate “psychological” boundaries from others?

19. Major Ego Functions (cont.) Impulse Control: Ability to distinguish between primary (drives or impulses) and secondary (planned) mental processes The ability to modulate, delay, inhibit or control the expression of impulses and affects (feelings) Does the client control his or her actions in accordance with social norms? Does the client ever lose control of behavior or emotions to a degree that creates significant problems in social functioning? Is the client internally constrained from action or emotional expression?

20. MAJOR EGO FUNCTIONS – (cont.) Interpersonal (Object) Relations: Ability to manage relationships appropriately toward goal achievement Ability to see other people as unique rather than replications of significant others from our past Development of one’s internalized sense of self and of others Evolution of the capacity for mature interpersonal relationships Questions: Does the client manage her/his relationships appropriately (toward personal goal attainment)? Does the client act as if other people are unique rather than replications of people from the past? Does he or she manage some types of relationships (such as work or social relationships) better than others (family or other intimate ties)?

21. MAJOR EGO FUNCTIONS – (cont.) Regulation of Thought Processes: Capacity to perceive, attend to stimuli, concentrate, anticipate, symbolize, remember and reason in order to undertake appropriate action. Communicates thought clearly through language (not circumstantial nor tangential) Thinking and speaking are organized, logical, oriented to reality rather than fragmented and irrational –Can the client control and direct thoughts for goal attainment? Maturing of thought process shifts from primary process thinking to secondary process thinking –Primary process characterized by wish-fulfilling fantasies and need for immediate gratification irrespective of its appropriateness. (magical thinking: what I wish will happen & I wished it and that is why it happened) –Secondary process characterized by ability to postpone instinctual gratification until reality conditions are appropriate. Replaces wish-fulfillment with action

22. MAJOR EGO FUNCTIONS – (cont.) Regression in Service of the Ego: An ability to permit oneself to relax the hold on reality. To experience aspects of self that are ordinarily inaccessible when engaged in concentrated attention to reality. Can emerge with increased adaptive capacity as a result of creative integrations –Is regression adaptive or maladaptive? Examples : –New baby comes into family and first child clings to mother –Parents are separating and youth demonstrates “little child” behaviors –Adult female engages in “baby talk” to get what she wants from another

23. MAJOR EGO FUNCTIONS – (cont.) Defense / Coping Mechanisms: Distortions of reality that allow one to minimize anxiety or fear. Adaptive defenses protect the individual from anxiety while simultaneously fostering optimal functioning Ex.: Accepting a terminal illness by not focusing continually on deat h Maladaptive defenses protect from anxiety but at the expense of optimal functioning Ex.: Noticing abnormalities in the body but deciding “it is nothing…..” In assessing defenses, which are prominent? Are they rigid or flexible? Do they seem to be adaptive or a source of conflict for the client?

24. Major Ego Functions (cont.) Stimulus Regulation: Regulating the amount of stimulation received so that it is optimal: neither too little nor too great. Humans are responsive to internal and external stimuli as a result of their sensorimotor apparatus. Individuals have different thresholds for stimulation Children exposed to excessive environmental, or internal stimulation resulting from frustration, may become overwhelmed and unable to self- regulate those stimuli. –Ex.: with sensory deprivation, may result in a craving for stimulation –Ex.: with sensory overload, may withdraw to cope Can the client screen and select external stimuli to maintain a focus on relevant life concerns? Does the client tend to become overwhelmed or underwhelmed?

25. Major Ego Functioins (cont.) Autonomous Functioning: Capacity to maintain attention, concentration, memory or learning These functions are autonomous from the drives, conflict free, and do not arise in response to frustration and conflict They are innate, developing and maturing given an “expectable” environment These functions can become impaired by being associated with conflict over the course of development –EX. Capacity to remember may be impaired by painful, anxiety-provoking or traumatic events –Ex.: Capacity to learn can be influenced negatively by withdrawal of parental love or negative attitudes when child shows curiosity Adults can lose autonomy in certain areas as a result of anxiety and conflict; also neurological challenges (organic or induced)

26. Ego Functions (cont.) Synthetic-Integrative Function: Capacity to organize mental processes into a coherent form. Synthetic function fits all the disparate aspects of the personality into a unified structure that acts upon the external world Synthetic function responsible for personality integration, resolution of spits, fragmentations, and conflicting tendencies within the personality Individual may show good ego functioning on selected characteristics but overall personality integration is deficient –Person may act in contradictory, fragmented, inconsistent, unpredictable or chaotic ways that reflect a lick of internal coherence

27. EGO DEFENSES Ego defenses are unconscious, automatic responses that enable us to minimize perceived threats or keep them out of awareness Function is to reduce anxiety Manner in which defenses are employed has a great influence on ability to manage problems and challenges They are coping mechanisms used by all people to protect themselves from becoming overwhelmed and to protect against anxiety Defenses also distort reality to varying degrees by providing a conscious perspective on a situation that is biased toward preserving a sense of security

28. Defenses in Ego Psychology (con.t) They are normal, healthy and universal processes. They can be evaluated in the following ways: Flexible (healthy) or rigid (unhealthy):? Ex.: Suppression of anger may be appropriate or inappropriate based on situation A rigidly defensive person will suppress or express angry feelings with insufficient regard for the context; thus more likely to create conflicts Future vs. past orientation?: Defenses should promote adaptive behavior in the present and future When use is based on past events no longer affecting client, they may be maladaptive

29. Defenses in Ego Psychology (cont.) Reality adherence or significant distortion? –All defenses distort reality but people can distort reality to such a degree that they lose awareness of their environment –Ex.: A somaticized complain causes a student to believe he has cancer; as a way to get out of an assignment Is adaptive functioning and goal achievement promoted? Does the defense minimize internal and interpersonal conflict?

30. AN EXAMPLE OF THE COMPLEXITY OF DEFENSES: ADAPTIVE VS. MALADAPTIVE DENIAL Denial of fact (an event has occurred) vs. denial of implication (what it means) When change is possible, denial may be maladaptive When change is not possible, denial may be adaptive (at least for awhile) The timing of denial (it may serve a positive purpose of helping us “gather our resources” to eventually deal with the challenge) Levels of denial: Facts The threat created by the information (its personal relevance) The urgency of the need to respond Emotional reactions

31. Common Defense Mechanisms Denial: Negating an important aspect of reality that one may actually perceive Displacement: Shifting negative feelings about one person or situation onto another Intellectualization: Avoiding unacceptable emotions by thinking or talking about them rather than experiencing them directly Introjection: Taking characteristics of another person into the self in order to avoid direct conflict. The emotions originally felt toward the other person are now felt by the self. –Identification : Modeling oneself after another via taking on values, attitudes, characteristics of a loved, feared or hated person. –Ex.: Boy may take on aggressive characteristics of a father whose violence threatens him, in order to deal with the anxiety related to his being victimized by his father –Internalization: Goes beyond identification by “taking in” another person and making him or her part of the self, rather than just “taking on” characteristics. It is defensive if used to ward off anxiety associated with being judged by having different views from another.

32. Common Defense Mechanisms (cont.) Isolation of Affect: Consciously experiencing an emotion in a “safe” context rather than the threatening context in which is was first unconsciously experienced. –Ex.: Unable to grieve a personal loss, the individual cries deeply when watching a movie where there is significant loss Projection: Individual attributes, to others, unacceptable thoughts and feelings that the person has, but are not conscious. –Attributing unacceptable thoughts and feelings onto others –Ex: Person has strong negative feelings toward another but believes the other has strong negative feelings toward her. –Diminishes capacity to test reality. Delusions may involve projections of one’s internal feelings onto the outside world

33. Common Defense Mechanisms (cont.) Rationalization Using convincing reasons to justify ideas, feelings or actions so as to avoid recognizing their true underlying motives Reaction Formation: Involves keeping certain impulses out of awareness via replacing the impulse with its opposite. Regression: Resuming behaviors associated with an earlier developmental stage or level of functioning in order to avoid present anxiety. –The behavior may help to resolve the anxiety –Ex.: First born child shows bed-wetting after new sibling is born Repression: Keeping unwanted thoughts and feelings entirely out of awareness. –A crucial mechanism in all neurotic behavior. –May involve loss of memory for specific incidents, especially traumtic ones or those associated with painful emotions

34. Common Defense Mechanims (cont.) Somatization: Converting intolerable impulses into somatic complaints Sublimation: Converting an impulse from a socially unacceptable aim to a socially acceptable one Suppression: Putting out of awareness, consciously, something that is disturbing and anxiety provoking –Ex.: Scarlett O’Hara phenomenon: “ I’ll deal with this tomorrow…”

35. Ego Psychology: Nature of Problems and Change Challenges arise from conflicts within the person or between the person and the external world Stressors a client experiences arise from: –Environmental demands –Inadequate ego functioning –Reactions to normal life transitions Focus of ego-based interventions: –Build new ego strengths –Use existing ego strengths more effectively Change is manifested by: –Client's ability to use her/his ego functions to enhance insight –Achieve greater mastery of challenges, crises or life transitions

36. Ego Psychology: Nature of Problems and Change (cont.) Goals of ego psychology intervention: –Enhance client's inner capacities through ego development –Modify or change environmental conditions –Improve fit between person’s ego capacities and environment conditions by working on both areas Clients helped to: – develop problem solving and coping skills –Achieve insight (self-underanding) through reflection on their strengths, limitations and resources –Maladaptive defenses may be confronted and appropriate defenses strengthened Clients should emerge from the intervention with an improved sense of self direction

37. Questions Guiding Assessment To what extent is the client’s problem a function of: Stresses imposed by her current life roles or developmental tasks? Situational stress or a traumatic event? Impairments in her ego capacities or of developmental difficulties/dynamics? Lack of fit between her inner capacities and her external circumstances What inner capacities and environmental resources does the client have that can be mobilized to improve her functioning?

38. SOME ASSESSMENT ISSUES RELEVANT TO EGO PSYCHOLOGY Reality Testing Orientation to time, place, and person Reaching appropriate conclusions about cause and effect relationships Reasonably accurate perceptions of external events and the intentions of others Differentiating one ’ s own thoughts and feelings from those of others Self-Concept Self-esteem An awareness of one's strengths and limitations An acceptance of one ’ s strengths and limitations

39. SOME ASSESSMENT ISSUES RELEVANT TO EGO PSYCHOLOGY - II Assess Emotional Functioning Capacity for emotional expressiveness and control Range of emotions the client expresses Appropriateness of affect (blunting?) Any evidence of mood disorders (such as depression, suicide) The social worker must understand cultural differences in emotional expression

40. Social Worker/Client Relationship Working alliance should feature: –Collaboration –Agreement on goals –Some level of mutual comfort Requires skills of: –Empathy ( perception and communication) –Authenticity (relating in a natural and sincere manner) Assessment of the positive and negative aspects of the relationship –Examining the clinical relationship over time may serve as the primary intervention –Dynamically replicative of prior relationships? Client factors affecting the nature of the relationship include: –Voluntary or involuntary status –Level of motivation –Ego stability –Cultural factors

41. TRANSFERENCE Initially defined as client’s unconscious projections of feelings, thoughts and wishes onto the practitioner who comes to represent a person from the client’s past Worker does not actually possess those characteristics but client acts as if she does Broadened definition: all client reactions to the practitioner both conscious and unconscious These include reactions based on experiences with similar types of people in the client ’ s past, and on here-and-now characteristics of the social worker

42. Positive vs. Negative Transference Positive - the client is attracted to the practitioner, which can facilitate the engagement process Negative - characterized by such feelings as anger, distrust, or fear that impede the client’s participation in the intervention Positive transference does not necessarily facilitate the client’s achievement of goals; nor does negative transference necessarily prevent goal achievement

43. Countertransference Initially defined as practitioner’s unconscious reactions to the client's projections Broadened to refer to effects of practitioner’s conscious and unconscious needs and wishes on her/his understanding of the clients Also means conscious attitudes and tendencies that worker has about types of clients –Ex: Being drawn to working with children or having an aversion to older adults Countertransference and transference exist in every relationship –Humans do not experience others only based on objective reality –We experience others how we wish them to be or fear they may be Practitioner's awareness of her/his emotional reactions helps to develop understanding about clinical decisions being made

44. Common Signs of Countertransference Reactions Dreading or eagerly anticipating a client Differing promptness in responding to client’s needs Thinking excessively about a client during non-work hours Having trouble understanding a client’s problems Being bored with a client Feeling angry with a client for nonspecific reasons Being unduly impressed with a client Feeling defensive or hurt by a client’s criticisms Performing tasks for clients that they are capable of doing for themselves Feeling uncomfortable about discussing certain topics with a client

45. Managing Countertransference Reactions Be aware of your emotional and physical needs as much as possible –Be wary of obtaining too much personal gratification at the expense of a client Understand the client’s cultural and community standards of behavior, so as to appropriately assess behavior in those contexts When appropriate, selectively use self-disclosure with the client to process countertransference feelings. –It is important for some clients to learn that negative feelings can be contained and processed

46. TWO TYPES OF INTERVENTION IN EGO PSYCHOLOGY Ego Sustaining: Help client to understand motivations and behaviors and to become mobilized to resolve present difficulties Psychological and environmental May be short or long-term Accentuates client strengths Promotes reflection, problem solving, motivation, action

47. TWO TYPES OF INTERVENTION IN EGO PSYCHOLOGY (cont.) Ego Modification: An exploration of past experiences and unconscious processes to assist in more adaptive social functioning and personality change More psychological, less environmental Tends to be longer-term Addresses defenses, arouses anxiety Seeks depth in uncovering developmental arrests and adjusting patterns of perception and action

48. EGO SUSTAINING INTERVENTIONS: SUSTAINMENT Sustainment is developing and maintaining a positive relationship What the Worker Does Sustaining techniques consist of: sympathetic listening, receptiveness, conveying an attitude of acceptance of the client’s worth and uniqueness while providing reassurance and encouragement Listens actively and sympathetically Conveys a continuing attitude of good will Demonstrates consistency in the relationship Directly expresses confidence or esteem Non-verbally communicates interest, attentiveness Realistically reassures the client about potential for goal achievement Realistically encourages the client to persist Possibly offers environmental support

49. What This Technique Does for the Client Promotes a confiding relationship Instills a sense of the worker’s competence and caring Provides an antidote to alienation Enhances morale and the determination to persist Inspires and maintains the expectation of help Creates a setting where confrontation can effectively take place

50. EGO SUSTAINING INTERVENTIONS: EXPLORATION/DESCRIPTION/VENTILATION Encouraging client’s emotional expressions for stress relief and to gain objectivity about problems What the Social Worker Does Elicits the client’s subjective and objective feelings and experiences about an area of concern Helps the client: Express those feelings Explore those feelings Maintain a focus on relevant feelings

51. What The Technique Does For The Client Feels less alone, less overwhelmed, more in control Is freed from incapacitating anxiety, guilt, depression Sees problems as more manageable Is moved to action Develops greater hope, confidence, motivation, self- acceptance More clearly recognizes his or her emotional reactions and emotional style Acquires insight Lowers defenses Develops positive feelings about the social worker

52. EGO SUSTAININING INTERVENTIONS: PERSON-SITUATION REFLECTION Considers dynamics of current challenges and their solution/s What the Worker Does Focuses on client’s current situation and relationships via perception or understanding of: –Other people and external realities –Nature of client’s behavior and its effect on others –Reasons for client’s behavior in specific situations –Evaluation of inner feelings, self concept, attitudes, values Makes comments, asks questions, offers tentative explanations that promote the client’s reflective capacity Leads rational discussion of the pros and cons of the client’s taking certain actions Assumes a moderately directive and structured stance, perhaps including confrontation Provides here and now interpretations (tentative explanations) of client behaviors

53. What This Technique Does for the Client Promotes a clearer evaluation of feelings, self-concept, attitudes, and values Produces a better understanding of others or some external situation Increases insight into the nature of his or her behavior and its effects on others Improves judgment and the ability to consider a wider range of problem solving options

54. EGO SUSTAINING INTERVENTIONS: ADVICE AND GUIDANCE (DIRECT INFLUENCE) What the Worker Does Makes suggestions about ways of thinking, reviewing feelings, or behaving Explores the client’s expectations when advice is requested (and if the request is denied, explains why) Gives advice in a context of reflective discussion, if possible Often guides the client to a decision rather than giving direct advice States an opinion Emphasizes a course of action the client is already contemplating Cautions the client against certain actions Manages the risks of giving advice openly with the client Avoids giving advice about most major life decisions Usually gives advice or makes suggestions tentatively Always acts to meet the client’s (not the worker’s) needs

55. What This Technique Does for the Client Promotes adaptive behavior for the client who is overwhelmed or in crisis Provides tentative solutions to problems or challenges that can be implemented and then reviewed (This technique may be required to connect with or meet the intervention expectations of some client populations)

56. EGO SUSTAINING INTERVENTIONS: PARTIALIZING (STRUCTURING) What the Worker Does Breaks down problems into manageable parts Focuses the intervention and the client’s attention Observes time limits Assigns homework (client activities outside the session) Engages in reflective discussion of the above steps (if practical) to promote the client’s insight

57. What This Technique Does for the Client Relieves the client’s sense of being overwhelmed Provides an action focus for clients in moving forward Provides new opportunities for learning Stimulates effort from the client Success experiences enhance the client’s sense of mastery and competence

58. EGO SUSTAINING INTERVENTIONS: EDUCATION What the Worker Does Provides information about environmental resources Provides information essential to the client’s functioning (biological, psychological, or social) Helps the client understand the effects of behavior on others Helps the client understand others’ needs and motivations May involve role plays, planning, promotion of new client behaviors

59. What This Technique Does for the Client Increases options for change Increases “fund of knowledge” for problem-solving activities Increases insight Increases investment in the process of intervention, if the worker’s strategies are perceived to be comprehensive

60. Ego Modifying Interventions: Pattern Dynamic Reflection Helps the client to identify and consider her/his pattern of behavior including defenses and their impact Goal is to help client to develop greater dynamic understanding of the nature of and reasons for this behavior May involve worker pointing out ( confronting) maladaptive, contradictory behavior as well as interpretations of its underlying reasons

61. Ego Modification Interventions: Developmental Reflection Help client to think about his past and the way it is affecting his current behavior Goal is to help client gain greater insight into the dynamics of his maladaptive behavior that may stem from irrational feelings and fears, from past conflictual situations or from developmental arrests

62. What These Techniques Do for the Client Pattern dynamic and developmental reflection promotes insight by making clients aware of maladaptive or irrational behavior, thoughts and feelings that may stem from conflict situations, or a developmental “arrest” This awareness/insight arouses anxiety and must be utilized with caution with clients who cannot tolerate anxiety Help to identify and consider long-standing patterns of functioning, including defenses and their relative effectiveness Encourages new habits of thought about the past and the ways it affects current behavior Provides a rationale for experimenting with new patterns of behavior These technique can be used with clients who have a capacity for reflection, but generally not with children and many younger adolescents

63. THE EGO AND THE ENVIRONMENT: DIVERSE POPULATIONS PERSON SOCIOPOLITICAL CONTEXT OF ENVIRONMENT Memberships Race Gender Economic Status Socialization Health Vulnerability to Trauma Oppression Culture and Acculturation Stigma EGO Ego Functions Coping Mechanisms Mastery & Competence Focus on memberships and strengths; build confidence, self esteem, personal power; provide options and choices; link client with resources; connect to mutual aid and peer groups, encourage collective and political action