Transcript Slide 1

I.
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The Concentration in
Interpersonal Practice:
One of two concentrations available to
advanced year graduate students in our
School – Continues two time-honored
traditions:
substantive and intensive education for
clinical practice
scholarly rigor
II. We offer students three tracks
or options to choose from among:
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cognitive-behavioral social work
practice
family-systems social work practice
psychodynamic social work practice.
Each of these options –
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is as rigorous and systematic as the other two,
and in fact designed to be comparable in every
major respect
requires a two-term commitment, totaling eight
credit hours over the academic year; students
may not select one term of one track and second
term of a different track
is conceived as a combined human behavior and
clinical methods course, and is further intended
to achieve integration along several different
axes:
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-- there is an equal and consistent focus on
children, adolescents, and adults in readings,
lectures, and clinical case review portions of the
course;
-- the focus on psychopathology/dysfunction is
counterbalanced by a comparable emphasis on
clinical diagnostic skills, whether these are
linked to the beginning, middle, or end stage of
the treatment process;
-- the content on clinical process dimensions is
complementary to content on clinical method
and technique;
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-- clinical case reviews permit a useful
integration of field experiences with didactic
classroom learning;
-- the variable of time and its implications for
interpersonal practice are identified and brief
models of treatment are elucidated;
-- ethical dimensions of practice, content on
human diversity, and material on socially
disenfranchised, marginalized, and vulnerable
populations are all accorded emphasis;
-- various models or paradigms for research on
aspects of clinical process and/or for the
evaluation of practice are also introduced.
III.
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How exactly did we decide on these
particular three theory bases?
each system is widely used in social work
practice today
each boasts a substantial clinical and research
literature
we have at least one full-time faculty member
with the expertise and background
We also decided that we would like to do a few
things well, rather than to offer a little bit of
everything
IV.
Finally, “which theory track
should I choose?”
[written material to be distributed]
illustration of how each of these theoretical
systems works – using material from the
film “Gilbert Grape”
Please remember, also, that selecting
one theoretical orientation doesn’t
lock you into that orientation
forever.
Behavior, Psyche, and System in “What’s
Eating Gilbert Grape?”
Three Clinical Approaches
Hallstrom, L. (Producer/Director) (1993). What’s Eating Gilbert
Grape? [Motion picture]. United States. Paramount Pictures.
Cognitive-Behavioral
Treatment &
Assessment
The Case of Gilbert Grape
Presented by:
Antonio Gonzalez-Prendes, Ph.D., ACSW
What is CBT?
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Problem-focused, present-oriented, time-limited
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Operates on basic assumptions:
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Cognition plays a central role in human adaptation
Emotional disorders result primarily from:
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Irrational, unrealistic, biased, rigid & distorted thinking
Thinking can be monitored & changed
Cognitive change → clinical improvement
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CBT is not “positive thinking”
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Thoughts are just thoughts, not facts.
CBT maintains that …
…information processing and meaning are central
in determining our emotional and/or behavioral
reactions.
…cognitions mediate/moderate these processes and
how we adapt to life’s events.
Cognitive Case Conceptualization
(Judith Beck, 1995)
Relevant Developmental/Childhood Data
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Core Beliefs
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Intermediate Beliefs
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Rules (“Shoulds”) / Conditional Assumptions (If…then…)
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Compensatory Strategies
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Automatic Thoughts (meaning of A.T.’s)
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Emotions
Behaviors
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Relevant developmental/childhood data
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Core Beliefs
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“I am unlovable/insignificant/not good enough”
Rules (reflect rigid responsibility & low self-worth)
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Father: Suicide. Depressed?
Mother: Stays home, overeats. Depressed?
“I should attend to others”, “I must do for others”
Conditional Assumptions
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“If I please others then I am worthwhile”
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Compensatory Strategies
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Automatic thoughts (when asked what he wants)
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Self-denial; passive; unemotional.
“I want to be a good person” (Contingent on pleasing
others?)
“I can’t do this, I can’t”
Emotions & Behaviors
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Emotions: Shallow, flat, resigned attitude, unexpressive.
Cannot bring himself to feel.
Resentment, bitterness, anger? → “Beached whale”
Behaviors: Does for others even when burdened. Unable to
set boundaries.
Treatment of Gilbert Grape
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What does Gilbert want? How would he like to think,
act, feel differently?
Get the “rest of the story”. Strengths? Abilities?
Awareness of his “cognitive set”.
Assess validity & functionality of beliefs and rules.
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Evidence, alternative explanations, pros & cons, etc.
Restructure rigid rules & negative core beliefs.
Build new cognitive & behavioral skills.
Use homework and behavioral experiments.
General → Specific; Vague/abstract→ Concrete.
A Family Systems
Perspective
Presented by Dr. Arlene Weisz
Family Systems Understandings
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There are a number of different models.
We are teaching an integrative approach
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For example, we can look at:
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allowing the social worker to combine the most
relevant parts of different models.
structure
emotional systems
or sequences of interactions
Include a focus on culture and gender
Structure
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Are the roles working well for the
family at this stage of
development?
Who is in charge?
What are the boundaries like
between individuals and between
the family and the outside world?
Emotional systems
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Does the family have some
strengths in terms of caring for
each other?
How does the family deal with loss
and separation?
How does the family deal with
conflict and anger?
Sequences of interactions
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Attempted solutions to mother’s
and Arnie’s difficulties—do they
really solve the problem?
What constrains people from
making changes?
Family Systems Interventions
Would keep family dynamics in
mind
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Whether meeting with whole family
Or Gilbert alone (most motivated for
change)
Recognize that changes made by one
person affect the whole family system
And that an individual’s behavior makes
sense in the context of the system
Would try to see the whole family at
least once
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Family meetings show the family’s
interactions to the social worker
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Rather than having an individual
describe what happens at home
During sessions, the family can
experiment with new interactions
with help from the therapist
Family meetings would focus on
Forming an alliance with all of the
family members
 Observing family interactions in
the here and now
 Developing goals the whole family
can agree on
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Goals might be to:
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Strengthen the family hierarchy
Teach problem solving
Increase individuality
Help the family face its grief
when the time is right
“What’s Eating Gilbert Grape?”
A Psychodynamic Perspective on
Clinical Assessment and Treatment
Presented by
Jerrold R. Brandell, Ph.D., BCD
Gilbert and the Mother of all Grapes
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oedipal victory/object loss
wishes and actions
seedling to grape – instantaneously
Gilbert’s childhood and adolescence
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what childhood and adolescence?
mirroring, self-calming and self-soothing
who’s the selfobject here, anyway?
Gilbert and Arnie
Gilbert and the G.F. (Girlfriend)
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girlfriend or dynamic therapist?
the defenses
free association
Gilbert’s (hypothetical) treatment
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the ‘six-session solution’
psychological growth via the
treatment relationship/”holding
environment”
potential pitfalls for the therapist
The process of dynamic therapy
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making unconscious conscious; “where
id was, there ego shall be”
the telling and retelling of the client’s
personal narrative
resistance
new adaptations
“What’s Eating Gilbert Grape”
What’s in a title?
SPECIAL INTEREST
AREAS FOR
INTERPERSONAL
PRACTICE STUDENTS
FAMILIES-AT-RISK
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FOCUS ON WORK WITH THE FAMILY UNIT
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FOSTER FAMILY, ADOPTIVE FAMILY, AT-RISK OF
SEPARATION
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ADDRESS ISSUES OF POVERTY,
INTERACTIONAL STRESSES, DEPRESSION,
CHILD MANAGEMENT CHALLENGES,
VIOLENCE
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IMPROVE FAMILY FUNCTIONING AND DEVELOP
RESOURCES
CHILD WELFARE
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FOCUS ON CHILD/ADOLESCENT AND SOME
DIRECT WORK WITH THE FAMILY
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SEPARATION FROM FAMILY AND COPING WITH
ADJUSTMENT ISSUES, BEHAVIORAL
DIFFICULTIES, DEPRESSION/ANXIETY
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FACILITATE ADJUSTMENT, FURTHER COPING
SKILLS, ASSIST WITH GREIVING, STRENGTHEN
ADAPTIVE SKILLS
SUBSTANCE ABUSE
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WORK WITH ALCOHOL AND DRUG PROBLEMS;
ADDRESS THEIR IMPACT ON THE INDIVIDUAL
AND FAMILY/SIGNIFICANT OTHERS
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MAY ADDRESS DUAL DIAGNOSIS ISSUES
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WORK IN INPATIENT, OUTPATIENT SETTINGS;
RANGE OF REHABILITATION MODELS
SCHOOLS
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WORK WITH SCHOOL PERSONNEL, TEACHERS, CHILDREN
(BOTH REGULAR AND SPECIAL EDUCATION); FAMILY
MEMBERS
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ASSESS EDUCATIONAL DISABILITIES IN CHILDREN;
COMPLETE INTERVENTION PLANS TO FURTHER STUDENT
LEARNING
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LEAD PSYCHOEDUCATIONAL GROUPS TO FURTHER
STUDENT ADJUSTMENT AND EDUCATIONAL SUCCESS
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MAY HAVE INVOLVEMENT IN COMMUNITY WORK;
DEVELOPING PARTNERSHIPS BETWEEN THE SCHOOL AND
THE COMMUNITY
MENTAL HEALTH
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SOCIAL WORK TREATMENT WITH INDIVIDUALS, FAMILIES
AND GROUPS; CHILD, ADOLESCENT AND ADULT CLIENTS
COPING WITH A RANGE OF PSYCHOSOCIAL DIFFICULTIES
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DEVELOP ASSESSMENT SKILLS, CRISIS INTERVENTION
SKILLS, TREATMENT SKILLS, GROUP WORK SKILLS, CASE
MANAGEMENT/DISCHAARGE PLANNING SKILLS
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WORK IN INPATIENT/OUTPATIENT SETTINGS
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COMMUNITY MENTAL HEALTH AGENCIES, FAMILY
SERVICE AGENCIES, HEALTH MAINTENANCE
ORGANIZATIONS (HMO)
HEALTH CARE
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WORK WITH THOSE FACING HEALTHRELATED
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DIFFICULTIES
DISABILITY
DEATH
ALL AGE LEVELS AND ALL SOCIAL
WORK MODALITIES
SETTINGS INCLUDE HOSPITAL,
HOSPICE, HOME CARE AGENCIES
AGING/GERONTOLOGY
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FOCUS ON NEEDS AND CONCERNS OF
OLDER ADULTS
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ADDRESS AGE-RELATED STRESSORS,
LIFE TRANSITIONS, LOSS ISSUES,
HEALTH CHANGES