Transcript Department of Social Work

UTPA
Department of Social Work
Social Work License Exam
Preparation Workshop
April 21, 26, & 28, 2007
1
Group Therapy and Family & Couple Theory
& Therapy
April 28, 2007
8:30am – 10:15am
Alonzo Cavazos, Ed.D., LCSW, LPC
(presentation adapted from Middleton & Mather, 2000
www.licenseprep.com
2
Group therapy
• Definition of group work
“Goal-directed activity with small treatment
and task groups aimed at meeting
socioemotional needs and accomplishing
tasks. This activity is directed to
individual members of a group and to the
group as a whole within a system of
service delivery – Roseland & Rivas,
2005.
3
Two Conceptualizations of Major
Types of Groups
1. Three models of social group work

social goals model (citizen education
groups

remedial model (therapy groups)

reciprocal model (mutual aid groups)
2. Task vs. treatment groups
4
Social Goals Model
• Purpose: To raise social consciousness,
social responsibility, informed citizenry,
and to inform political and social action.
• Used in settlement houses and
neighborhood centers
• Group worker as role model/enabler
5
Remedial Model
• Purpose: To restore/rehabilitate
individuals exhibiting dysfunctional
behavior
• Group worker is change agent – therapy
involves assessment and interventions to
assist group members to achieve
treatment goals.
• Used in clinical outpatient/inpatient
settings.
6
Reciprocal Model
• Purpose: To provide mutual aid to group
members in achieving optimum adaptation,
socialization
• Group worker functions as mediator between
members, groups, and society to assist all
concerned in getting their needs met.
• Can be used in clinical inpatient/outpatient
settings and in neighborhood, community
centers.
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Task vs. treatment groups
Task groups
•Goal: to accomplish a specific task
•General Characteristics:
The standard for success is the
accomplishment of the task
Communication focuses on the task at hand
Low self-disclosure
Important that members have the requisite
interest, knowledge base, and skills to achieve the
purpose of the group.
8
Treatment groups





• Goal: to increase the ability of members to
meet their socioemotional needs
• General Characteristics
open communication is encouraged among
members
the roles of group members naturally evolve
high disclosure
confidentiality expected
success is defined as the achievement of
individual and group goals.
9
Group Composition – caveats
• In general, homogeneous groups tend to gel
faster, become more cohesive, offer more
immediate support to group members, have
better attendance and less conflict, and provide
more symptomatic relief; they can however,
remain superficial and are ineffective for altering
character structure.
• Group therapy is not indicated for children
younger than 8.
10
Group Composition – caveats
(continued)
• In general, inclusion of both genders in groups
for children is not recommended; some
adolescents can handle mixed groups; mixed
groups have the most lasting effect for adults.
• Glaver and Gavin maintain that a group that is
too homogeneous, in terms of undesirable
characteristics (deviant behavior), will reinforce
these behaviors.
• Group size – for treatment groups (7 -10)
11
Open vs. closed groups
• Closed groups are most effective for shortterm, task-oriented therapy, and for groups
conducted in inpatient settings.
• Open groups offer members fresh input
and allow them to benefit from the success
of graduates but can often impede the
development of trust, acceptance, and
cohesiveness.
12
Group Stages
• Prescreening (ensure best fit for group)
• First stage (orientation, norming, search
for meaning, dependency)
• Second stage – conflict dominance
(storming)
• Third stage – development of cohesion
• Forth stage – working stage (performing)
• Fifth stage – disengagement/termination
13
Types of Treatment Groups
• Support group (e.g. single fathers)
• Educational group (group to educate
adolescents at AIDS)
• Growth Group (marriage enrichment
group)
• Therapy Group (group for adults
molested as children)
• Socialization Group
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Therapeutic Factors (Irvin D.
Yalom)
1.
2.
3.
4.
5.
Instillation of Hope
Universality (“We are in the same boat”)
Imparting of information
Altruism (unselfishness)
The Corrective Recapitulation of the
Primary Family Group
6. Socialization Skills
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Therapeutic Factors (Yalom)
•
•
•
•
Imitative Behavior
Interpersonal Learning
Group Cohesiveness
Catharsis (open expression of strong emotional
feelings)
• Existential factors
–
–
–
–
Recognizing that life is at times unfair.
Recognizing – no escape from pain, suffering & death
Can get close, but still have to face life alone.
Having ultimate responsibilities for one’s life.
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Test Question
•
Yalom believes that the use of individual
therapy with group therapy
a.
b.
c.
d.
Brings about changes sooner
Works together for more significant change
Is not effective
Can be effective if the therapist is the same
for both
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Test Answer
• Yalom believes that the use of individual
therapy with group therapy
a.Brings about changes sooner
b.Works together for more significant change
c.Is not effective
d.Can be effective if the therapist is the same
for both
Other theorists believe differently if the
therapist is same for both.
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Test Question
•
As a social worker in a child abuse center, you
create a group for abusive parents. During the
first session, one of the parents becomes
angry and starts to argue with another parent.
You should handle this situation by
a. Asking the parent to explain what caused her anger
b. Having the parents work through the disagreement
in an appropriate manner
c. Insisting the parent stop arguing
d. Allowing the parent to vent her anger
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Test Answer
• “b” -- Having the parents work through the
disagreement in an appropriate manner.
Rationale: What created the anger is not
nearly as important as learning to resolve
conflicts in appropriate ways.
20
Test Question
•
A teenage drug abuse group becomes
hostile, and the social worker fears that
violence will break out. It is important for
the social worker to first
a.
b.
c.
d.
Try to de-escalate the group
Ask the two most difficult members to leave
Call for help
End the group
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Test Answer
• “a” -- try to de-escalate the group
Rationale: This question asks what the
social worker should do first. If the fails,
then the worker may have to terminate the
group or call for help.
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Test Question
•
There are many different types of groups
that social workers lead. The type of
group most associated with selfimprovement and opportunities to
expand self-awareness is
a.
b.
c.
d.
The therapeutic group
The socialization group
The growth group
The recreational group
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Test Answer
• There are many different types of groups
that social workers lead. The type of
group most associated with selfimprovement and opportunities to expand
self-awareness is
a.The therapeutic group
b.The socialization group
c.The growth group
d.The recreational group
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Test Question
•
While holding a first session of a group for
newly divorced clients, a woman begins
discussing her anger with men in general.
One man in the group begins to appear
uncomfortable, while another starts to argue
with the woman. What is the most likely
reason for the men’s responses?
a.
b.
c.
d.
Transference
Interpersonal conflict
Projection
Complimentary Ego-states
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Test Answer
a. Transference
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Test Question
•
a.
b.
c.
d.
A member of the group comes in late.
The leader confronts her for coming in
late. The group argues with the leader
for confronting the member. This is an
example of:
Scapegoating
Cohesion
Resistance
Universality
27
Test Answer
“b” - cohesion
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Family Therapy: Key Points
• Focuses on the whole system of
individuals, interpersonal patterns, &
communication patterns
• Seeks to clarify roles and reciprocal
obligations and encourage more adaptable
behaviors among the family members
• Variations in techniques practiced by
proponents of different family therapy
orientations.
29
Family Therapy Models
1. Family Systems theory (Murray Bowen)
2. Communications/Experiential Family
Therapy (Mental Research Institute)
3. Virginia Satir
4. Structural Family Theory (Salvadore
Minuchin)
5. Strategic Family Therapy (Jay Haley)
6. Milan Systemic Therapy (Mara Selvini
Palazzoli)
30
Family Systems theory (Murray
Bowen)
• The goal of therapy - differentiation of self for all
family members.
• Therapy often involves work with one family
member, the premise being that when one
member changes, the other will follow.
• Each member is helped to take responsibility for
his/her own role in the problem (s).
• Communication is directed to the therapist.
• Reduction of anxiety is critical for success
31
Bowenian Theory
• interlocking concepts

differentiation of self

undifferentiated family ego mass (fused
identities)

triangles

nuclear family emotional processes (emotional
forces)

emotional cutoff (severing ties with parents)

sibling position

family projection process (next slide)

multigenerational transmission process
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Bowenian Theory
family projection process – the process
through which parents transmit their lack
of differentiation unto their offspring.
multigenerational transmission process –
has reference to the transmission, through
the generations, of the family’s emotional
process.
33
Test question
•
A family therapist who deals with
separation from family of origin is
generally using
a.
b.
c.
d.
Bowen
Jackson
Satir
Milan
34
Test Question
During the initial family therapy session, the parents of a17year-old boy complain about the activities he engages in
without their permission. These activities include failing to
maintain curfew hours, engaging in smoking and drinking,
and telling his parents to “stuff it.” The parents are
concerned about this behavior, and the father keeps
referring to his own such “thoughtlessness” at the same
age when his father was angry with him. The family
therapist would describe this as
a. Delinquent behaviors
b. Scapegoating
c. Family of origin issues
d. Potential signs of deviant behaviors
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Test Answer
• “c” - Family of origin issues
The father appears to be responding to his
son’s behavior from the context of his own
experience as a child in his parents’ home.
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Test Question
•
If you utilize Bowen’s brand of therapy, it
would be important to
a.
b.
c.
d.
Discuss transference
Coach clients
Give directives
Teach the power of touch
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Test Answer
• ‘b” – coach clients (which is major
component of Bowen’s work)
38
Communications/Experiential
Family Therapy
• Theorists: Gregory Bateson, Don Jackson,
Virginia Satir, & Jay Haley.
• Primary purpose of symptoms is the
maintenance of homeostasis in the family.
• Pathological families are seen as being stuck in
strong dysfunctional communication patterns
and who view any change as a threat to the
integrity of the system.
• Goal of therapy: alter the interactional patterns
that the maintain the presenting symptoms.
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Communications/Experiential
Family Therapy
• 2 levels of communication (report &
content (manifest) & command level
(latent)
– For example: Have dinner ready by 6pm.
– Command level: metacommunication or a
covert message (I am the boss)
2 types of relationships
Symmetrical – egalitarian
Complementary – relationships that involve a fit
between different roles
40
Communications/Experiential
Family Therapy
• Principle of equifinality – same results in therapy
can be obtained via different means.
• Circular model of causality – behaviors of
different subsystems reciprocally impact each
other.
• Dysfunctional communication (some examples)
– Blaming, mind reading, incomplete sentences,
disqualification of the communication of another
member, and over generaliziang
41
Test Question
•
All of the following are circular models of
causality except
a.
b.
c.
d.
Blaming and criticizing
Mind reading
Over generalizing
Scapegoating
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Test Answer
• “d” – scapegoating
• This is an information question that uses
except one of the following
43
Test Question
•
During a family therapy session, the teenage
daughter begins accusing her mother of being
abusive and of neglecting her needs. The
mother responds very passively and does not
defend herself, while the father attempts to
take control of the session. The social worker
needs to examine the family situation for
a.
b.
c.
d.
Sexual abuse
Individuation issues
Triangulation
Substance abuse
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Test Answer
• “a” sexual abuse
• In situation involving incestuous sexual
abuse, fathers are often highly controlling
and the mothers are often passive.
45
Virginia Satir
• Satir assisted each family member to
become as whole as possible through
deliberate efforts to build self-esteem/selfworth and through the correction of
dysfunctional communication patterns.
46
Virginia Satir (continued)
• Five Styles (poses) of Communication

Placater – agrees, apologizes, tries to
please

Blamer – accuses, criticizes, and dominates

Super-reasonable – calm, cool, emotionally
detached

Irrelevant – seeks to distract

Congruent communicator – sends clear,
straight messages, & is genuine
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Test Question
• During a session with a family of 2 parents & 5
kids, the youngest child spends a lot to time
trying to get the mother’s attention. The mother
tends to get distracted when the therapist asks
her questions about her relationship with her
husband. Which role is the youngest playing?
• Scapegoat
• Distractor
• Support
• Surrogate Partner
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Structural Family Theory
(Salvadore Minuchin)
• Theory premise – all families have an underlying
organization (structure), which may be adaptive
or maladaptive.
• Important concepts (some examples)

subsystems

alignments (coalitions between subsystems)

power hierarchies (distribution of power)

interpersonal boundaries

Disengagement

Enmeshment
49
Structural Family Theory
• Treatment techniques
Joining – therapist’s entrance into the family’s
interactional system by 1) forming strong
bonds, 2) acknowledging the various
perspectives, 3) accommodating the family’s
organization and patterns.
Enactment
Reframing – redefining the family’s perspective
on the problem
50
Scenario
• During a family session, the husband
begins to criticize the wife over her
reluctance to exercise with him during
the morning as she used to do. The
youngest son begins to move his chair
closer to the mother as this exchange
occurs. You comment on the son’s
movement of the chair between the
husband and wife and explain how the
chair is like a fence.
51
Test Question
•
Structural family therapy is most likely
the type of a family therapy being used
because
a. Structure was the focus of the intervention
b. It is the most empirically tested of the family
therapies
c. The therapist shares his observations with
the family
d. The therapist doesn’t confront the husband
about his criticism
52
Test Answer
• Structural family therapy is most likely the
type of a family therapy being used
because
a.Structure was the focus of the intervention
The therapist focuses on interpersonal
boundaries and alignments.
53
Test Question
•
Your fist step in dealing with the issue
raised in the above scenario would be to
a.
b.
c.
d.
Explain the structural emphasis
Provide a directive
Place the son in another chair
Discuss the metaphor with the parents
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Test Answer
• “c” - place the son in another chair
55
Test Question
•
The child’s reaction may also reflect on
the ___ of the family.
a.
b.
c.
d.
Rules
Subsystems
Individuation
Secrets
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Test Answer
• “b” – subsystems ( mother/son,
husband/wife, or father/son)
57
Test Question
•
A structural family therapist’s initial action
is to
a.
b.
c.
d.
Diagnose the family
Direct the family
Join with the family
Interpret the family issues
58
Test Question
•
Structural family therapy is
a.
b.
c.
d.
Effective with all ethnic groups
Based on the work of Minuchin
Not effective with African Americans
Based on the work of Haley
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Strategic Family Therapy
(Jay Haley)
• Emphasis – change techniques over theory.
• Distinguishing Characteristics
 Rapid change
 Uses resistance of family members in the service of
change
 Communication is seen as defining relationships
(every relationship involves a struggle for power as to
who defines the relationship).
 Symptoms are tactics to control
 Finding alternative ways of defining relationships.
60
Strategic Family Therapy
• Techniques

therapist takes charge role

directives (therapist tells family members
precisely what tasks she/he wants them to
perform.

Paradoxical directives (for example:
prescribing
symptoms – asking members to resist certain things.

Ordeals (making the client’s symptoms too much
trouble for the client to continuing having them)

Restraining (warning the family about changes)

Reframing (offering more favorable explanation)
61
Milan Systemic Therapy (Mara
Selvini Palazzoli)
• Is a form of strategic therapy which focuses on
the struggle for power and the protective role of
symptoms.
• Techniques
Hypothesizing about the presenting problem (presession)
Neutrality (avoidance of allying with family members
Rituals – engaging family members in repetitious
behavior designed to counter dysfunctional family
rules
62
Milan Systemic Therapy
(continued)
• Paradoxical prescription/directive –
prescribing the problem behavior
• Positive connotation (reframing)
• Circular questions (members are asked
q questions that assist them to think in
relational terms and that help them to try
to understand the perspectives of other
members).
63
Milan Systemic Therapy
(continued)
• Therapy Stages
1. Pre-session (formulate hypothesis(es)
2. Session (modify hypothesis based on
information gained in the interview)
3. Intersession (decided on the
intervention)
4. Intervention (implement the intervention)
5. Post-session (discuss family’s response
and plan for next session)
64
Definitions
• Open system – family accepts information from external
systems. Closed system – the opposite
• Homeostasis – the balanced state systems seek to
maintain.
• Negative feedback loop – input that maintains the
status quo of a system.
• Positive feedback loop – input that forces a system to
change.
• Multifinality – the same beginning point may lead to
different results.
• Equifinality – different beginning points may lead to the
result.
65
Test Question
•
a.
b.
c.
d.
A technique to describe family structure
and relationships is:
Genogram
Sculpting
Fishbowl
Psychodrama
66
Test Answer
• A technique to describe family structure
and relationships is:
a. Genogram
b. Sculpting
c. Fishbowl
d. Psychodrama
67
Test Question
• Healthy family boundaries are:
a. rigid
b. cohesive
c. semi-permeable
d. normal
68
Test Question
• Healthy family boundaries are:
a. rigid
b. cohesive
c. semi-permeable
d. normal
69
Test Question
• Family therapy is contraindicated when:
a. Family members are grossly deceitful
and destructive to one another.
b. There is evidence of consistent
violation of generational boundaries.
c. Family myths and secrets appear to be
the family style.
d. The identified client is resistant and
unmotivated.
70
Test Answer
• Family therapy is contraindicated when:
a.
Family members are grossly deceitful
and destructive to one another.
b.
There is evidence of consistent violation of
generational boundaries.
c.
Family myths and secrets appear to be the
family style.
d.
The identified client is resistant and
unmotivated.
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