Monday, July 25, 2016

Introductory Guide to Hospice and Palliative Care Social Work

Introductory Guide to Hospice and Palliative Care Social Work

Friday, July 22, 2016

How Social Workers Help Struggling Teens

By Frederic Reamer, PhDand Deborah Siegel, PhD, LISCSW

Introduction Special Schools and Programs
Warning Signs Substance Abuse and Truancy Courts
How to Find Help How Social Workers Help
Cost of Programs and Services Resources
Crisis Intervention


Introduction
The adolescent years can be very challenging for some teenagers and their families. While adolescence can be an emotionally intense, stormy phase for virtually all teenagers, sometimes a teen’s struggles require special intervention. Many teens struggle with issues related to mental health, family relationships, friends, school performance, substance abuse, sexuality, and other high-risk behaviors.
Warning Signs
Struggling teens usually show signs of distress. Common warning signs include:
  • Low self-esteem
  • School failure and truancy
  • Defiance towards authority (such as parents, teachers, police)
  • Running away from home
  • Choosing the “wrong” friends
  • Impulsive behavior (such as speeding, taking other unsafe risks)
  • Getting in trouble with the law
  • Depression
  • Abusing alcohol or drugs
  • Social isolation
  • Eating disorders (overeating, not eating, self-induced vomiting)
  • Self injury (such as cutting)
There is help for these youngsters and their families through many avenues.
How to Find Help
There are many ways to locate and access programs and services for struggling teens. Initially parents can seek help by contacting school personnel (guidance counselors, social workers, administrators), family service agencies, community mental health centers, other community-based social service programs designed specifically for at-risk youngsters and their families, public child welfare agencies, family and juvenile courts, and specialty courts (such as truancy and drug courts).
Social workers can help parents and struggling teens identify and explore difficult and challenging family issues. Individual, family, and group counseling provided by clinical social workers may help parents and teens improve their communication skills and relationships, resolve conflicts, and address important mental health issues.
Professionals called “educational advocates” and “educational consultants” may be able to help parents and teens obtain needed services. Educational advocates, who are often attorneys, help people obtain specialized educational services. Educational advocates charge parents a fee and work with local, state, and federal education officials to ensure that students receive the services and “special accommodations” to which they are entitled by law. Advocates may file claims in court to force school districts to provide or pay for special-needs services and programs outside the school district.
Educational consultants help parents locate programs and services designed to meet their child’s needs. Educational consultants charge parents a fee, assess each teen’s unique strengths and needs, and help the family find the most appropriate schools or programs for their teen. Many educational consultants monitor students’ progress in the new program or school and, when necessary, advocate for the teen with that program or school when challenging issues arise.
Cost of Programs and Services
Programs and services for struggling teens can be very expensive. Some families are able to pay for these programs and services “out of pocket.” Some families have health insurance that pays for all or part of the program, or the public school system may pay the cost.
Many families cannot afford needed programs and services, do not have adequate insurance, and are unable to obtain funding from their public school department. In some instances families that cannot afford needed services agree to give legal custody of their teen to the local public child welfare agency, which then funds the services or programs (in several states the public child welfare agency will fund services without requiring that parents hand over legal custody). In still other circumstances, desperate parents may turn to the juvenile or family court and formally request that the teen be declared “wayward,” thus enabling the court to require the child to accept intervention. In these cases the state typically pays for needed services and programs. Some parents may be reluctant to use this route to services because the court, not they, determine where the child goes for help.
There is a wide range of services and programs run by private and public agencies for struggling teens and their families. Some programs may be available locally; however, some programs may be in other communities or states, which means that the teen must live away from home in order to receive needed services.
Crisis Intervention
A broad range of professionals and agencies offer crisis intervention and follow-up counseling services to teens and families. These services may be available through family service agencies, community mental health centers, hospital outpatient clinics, public child welfare departments, and psychotherapists in private practice (such as clinical social workers, clinical and counseling psychologists, mental health counselors, pastoral counselors, psychiatric nurses, and psychiatrists).
Many communities offer comprehensive counseling and family-intervention programs specifically for teens and families in crisis. These programs – known by names such as “comprehensive emergency services” or “comprehensive intensive services” – provide home-based assessment, emergency counseling, information, and referrals for longer term help.
Special Schools and Programs
A variety of alternative schools, therapeutic schools, and treatment programs serve teens who struggle with significant behavioral, emotional, mental health, and substance abuse issues. Some programs, such as alternative high schools, focus primarily on education while being sensitive to students’ mental health and behavioral challenges. Other programs, such as residential treatment programs, therapeutic boarding schools, and wilderness therapy programs, focus primarily on mental health, emotional and behavioral issues, while including an educational component. “Emotional growth” boarding schools address mental health, emotional, behavioral, and educational issues simultaneously. Other boarding schools focus on specific learning disabilities while also paying attention to the whole student. In short, different programs give different degrees of emphasis to personal and academic issues.
Parents of struggling teens – particularly teens who are oppositional and defiant – may be tempted to place their child in a school or program that promises to impose needed discipline and structure. Often these schools and programs – such as some military boarding schools and those that advertise their mission as “character education” – do not provide the mental health services many struggling teens need. These schools and programs can cause more harm than good for struggling teens who have personal and mental health issues that contribute to their challenges.
Prominent program options include:
  • Alternative high schools provide education, including special education services to teens who have floundered academically or socially in traditional high schools. These schools may be freestanding or sponsored by a community mental health center, family service agency, school district, or a “collaborative” composed of several social service and educational programs.
  • Youth diversion programs typically attempt to help struggling teens who have had contact with the police avoid more formal involvement in the juvenile justice system (juvenile courts and correctional facilities). Typical youth diversion programs offer first offenders individual and family counseling, links to other needed services (such as psychiatric medication), and education.
  • Independent living programs are designed to help adolescents develop the skills they need to live independently. These programs primarily serve teens who do not have stable families and are in the state’s custody. Some independent living programs also serve teens whose families are able to pay for these services privately. Typical services include practice in daily living skills, money management, career and educational planning, mental health services, housing assistance, recreational, and social activities and case management.
  • Wilderness therapy programs offer highly structured intensive short-term (three to six weeks) therapy in remote locations that remove adolescents from the distractions available in their home communities (such as television, music, computers, cars, drugs and alcohol, movies, delinquent peer groups). The challenges of living full-time outdoors and developing wilderness survival skills help teens develop self-confidence and pro-social behaviors. Often, families are advised to send their struggling teen first to a wilderness therapy program and then to a therapeutic or emotional growth boarding school, rather than return the teen to their home community environment.
  • Boarding schools for teens with significant learning disabilities offer structured academic programs that focus on education and learning while addressing relevant emotional and behavioral issues.
  • Emotional growth boarding schools offer structured academic programs and focus on emotional development and personal growth but do not provide the intensive treatment services offered by therapeutic boarding schools.
  • Therapeutic boarding schools focus intensively on students’ mental health, substance abuse, and behavioral needs while also providing an academic educational program.
  • Residential treatment centers offer highly structured treatment addressing substance abuse, family, and other mental health issues. In contrast with therapeutic boarding schools, residential treatment centers are more like a psychiatric hospital than a school, although they may have an academic/educational component in their program.
Substance Abuse and Truancy Courts
Many communities run substance abuse courts (sometimes known as drug courts) and truancy courts. These specialty courts use a supportive and nurturing approach rather than a punitive one to help struggling teens. Using case management, counseling, tutoring, mentoring, and parent education, the courts’ goal is to prevent future problems and more formal involvement with the juvenile justice system.
How Social Workers Help
Social workers can provide struggling teens and their families with:
  • Assessment of the teenager’s and family’s needs and strengths
  • Information about and referral to needed programs and services
  • Information about financial and legal issues and resources
  • Names of reputable educational advocates and educational consultants
  • Crisis intervention counseling services
  • On-going psychotherapy for the teen, the parents, and the family as a whole
  • Case management (helping staff from multiple agencies coordinate and communicate on behalf of the teen, and advocating for the family with these providers)
  • Information about important “warning signs” of teens who are on a downward spiral and the steps needed to get help
  • The National Association of Social Workers provides a listing of social workers in your area who can help you with these issues. Please click here to find a social worker.
Resources
Information about services and programs for struggling teens and families is available from social workers, schools, public child welfare agencies, juvenile and family courts, family service agencies, community mental health centers, educational advocates, educational consultants, and lawyers. Useful Web sites include:

Frederic G. Reamer, PhD, is the author of The Pocket Guide to Essential Human Services which contains diverse resources compiled into a user-friendly guidebook appropriate for use by professionals, volunteers, and consumers.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.

Common Myths and Why They are Wrong

Domestic violence only happens to poor women and women of color.

  • Domestic violence happens in all kinds of families and relationships. Persons of any class, culture, religion, sexual orientation, marital status, age, and sex can be victims or perpetrators of domestic violence.
Some people deserve to be hit.
  • No one deserves to be abused. Period. The only person responsible for the abuse is the abuser.
  • Physical violence, even among family members, is wrong and against the law.
Alcohol, drug abuse, stress, and mental illness cause domestic violence.
  • Alcohol use, drug use, and stress do not cause domestic violence; they may go along with domestic violence, but they do not cause the violence. Abusers often say they use these excuses for their violence. (Michigan Judicial Institute, Domestic Violence Benchbook, 1998, p. 1.6 - 1.7)
  • Generally, domestic violence happens when an abuser has learned and chooses to abuse. (Michigan Judicial Institute, Domestic Violence Benchbook, 1998, p. 1 - 5)
  • Domestic violence is rarely caused by mental illness, but it is often used as an excuse for domestic violence. (Michigan Judicial Institute, Domestic Violence Benchbook, 1998, p. 1 - 8)
Domestic violence is a personal problem between a husband and a wife.
  • Domestic violence affects everyone.
  • About 1 in 3 American women have been physically or sexually abused by a husband or boyfriend at some point in their lives. (Commonwealth Fund, Health Concerns Across a Woman's Lifespan: the Commonwealth Fund 1998 Survey of Women's Health, 1999)
  • In 1996, 30% of all female murder victims were killed by their husbands or boyfriends. (Federal Bureau of Investigation, 1997)
  • 40% to 60% of men who abuse women also abuse children. (American Psychological Association, Violence and the Family, 1996)
If it were that bad, she would just leave.
  • There are many reasons why women may not leave. Not leaving does not mean that the situation is okay or that the victim want to be abused.
  • Leaving can be dangerous. The most dangerous time for a woman who is being abused is when she tries to leave. (United States Department of Justice, National Crime Victim Survey, 1995)

    MANY VICTIMS DO LEAVE AND LEAD SUCCESSFUL, VIOLENCE FREE LIVES.

Thursday, July 21, 2016

So Why Do They Stay?

By Linda A. Osmundson

Slapping, hair-pulling, kicking, biting…battered women relate a litany of abuse experienced at the hand of our intimate partners. The results are bruises, broken bones, black eyes, internal injuries, sometimes and death. Always there are broken hearts.
Yet, most battered women really do not want to leave their abusive partners. Many of the women who call shelter crisis lines tell the staff and volunteers that they just want the abuse to end. We hope for fantasy TV endings like the lives of Claire and Heathcliff Huxtable or Ward and June Cleaver.
So why do we stay? When the person who had promised to love and cherish us beats us, what makes us stay for the second and third beating? When I speak to community groups about domestic violence, I am nearly always asked this question. Often women in the audience would exclaim, "if my partner laid a hand on me, I would be out the door!"
Imagine, for a moment, your own family. Would you really be able to walk out the door? Could you leave your home, neighborhood and friends? Where would you go? Could you, your two lively children, plus the dog, stay at your brother’s apartment on his couch for an indefinite period of time? What would his two roommates have to say about that? Could you stay with your parents who live in one of those adults-only condos?
I would not be surprised if the first time it happened you would help your partner rationalize why it happened. Your partner was (tired, stressed, angry, drinking, jealous, upset about losing a job or worried about expenses). Any excuse will fill the blank! YOU (made a mistake, came home late, disagreed with your partner, bought lunch at the mall….) fill this blank with the reason your partner says you caused the abuse.
But abuse is not about reason. It is about power. It is about control of one’s partner. And it works. The physical abuse is only the most obvious. It is reinforced by a whole spectrum of other kinds of abuse. We’ve already mentioned the excuses, the minimizing and blaming, saying it was her fault or it really wasn’t that serious. Abusers isolate their victims and keep them from having friends or family around. They control what we do, who we see, what we read and where we go.
Abusers abuse our psyche and emotions by calling us unprintable names, humiliating us, constantly criticizing us.
Abusers are intimidating. I knew an abuser who left a single bullet on the kitchen counter! It takes only a look, a threat, to instill fear. Abusers are coercive, threatening to leave, forcing us to participate in illegal activities. Abusers make sure we have no money, keep us from getting a job, making us put our check in to their account. Abusers treat their partners like servants, acting like "master of the castle," making all the important decisions.
Finally, abusers use the children by making us feel guilty about them, threatening to take the children, using the children to relay messages to their mother.
Abuse works because many of us continue to pretend it does not happen to "good" women. So anyone who is abused must be "bad"! We blame the victim for her own abuse by calling her codependent. We expect her to prevent the abuse instead of why the abuser chose to abuse. In short, we collude with the abuser.
Abusers succeed because they are not abusive all the time. In fact, sometimes they are fun and charming. They are almost always charming around other people.
Battered women stay because we are afraid. We are afraid no one will believe the truth. We fear we will lose our children. We are afraid we will have nowhere to go. We are fearful we will not be able to support the children. We are afraid our church or family will condemn us. We are terrified the abuser will hurt our friends or family. Ultimately, we fear we will be killed trying to leave.
All these fears are legitimate. Most battered women, killed by their abusers, have tried to leave. Some die in the process of leaving and many are killed trying to start over. The blood of millions of battered women is on the hands of friends and families, social workers, clergy, doctors, police, attorneys, judges and anyone else who failed to believe them, failed to heed their pleas for help.
Maybe we should reverse that question, "why does she stay?" and ask, "So why does the abuser abuse?" With all the obstacles in our path the real question is, "How can we possibly leave?"

Wednesday, July 20, 2016

Signs to Look for in a Battering Personality

Many women are interested in ways they can predict whether they are about to become involved with someone who will be physically abusive. Usually battering occurs between a man and a woman, but battering also takes place in same-sex relationships. Below is a list of behaviors seen in people who beat their partners; the last four signs listed are battering, but many women do not realize that this is the beginning of physical abuse. If a person exhibits several of the other behaviors, say, three or more, there is strong potential for physical violence. The more signs a

person has, the more likely the person is a batterer. In some cases, a batterer may have only a few behaviors that the woman can recognize, but they are very exaggerated (for example, will try to explain the behavior as a sign of love and concern); a woman may be flattered at first. As time goes on, the behaviors become more severe and serve to dominate and control the woman.
  1. JEALOUSY. At the beginning of a relationship, an abuser may say that jealousy is a sign of love. Jealousy has nothing to do with love. It is a sign of possessiveness and lack of trust. The abuser may question his partner about who she talks to, accuse her of flirting, or be jealous of time she spends with family, friends, or children. As the jealousy progresses, he may call her
    frequently during the day or drop by unexpectedly. He may refuse to let her work for fear she'll meet someone else, or even engage in behaviors such as checking her car mileage or asking friends to watch her.
  2. CONTROLLING BEHAVIOR. At first the batterer will say this behavior is due to his concern for her safety, her need to use her time well, or her need to make good decisions. He will be angry if the woman is "late" coming back from the store or an appointment; he will question her closely about where she went and who she talked with. As this behavior progresses, he may not let the
    woman make personal decisions about the house, her clothing, or even going to church. He may keep all the money or even make her ask permission to leave the house or room.
  3. QUICK INVOLVEMENT. Many battered women dated or knew their abuser for less than six months before they were married, engaged, or living together. He comes on like a whirlwind, claiming, "you're the only person I could ever talk to", or "I've never been loved like this by anyone." He will pressure the woman to commit to the relationship in such a way that later the woman may feel very guilty or that she's "letting him down" if she wants to slow down involvement
    or break off the relationship.
  4. UNREALISTIC EXPECTATIONS. Abusive people will expect their partner to meet all their needs. He expects a perfect wife, mother, lover, friend. He will says things such as "if you love me, I'm all you need, and you're all I need." His partner is expected to take care of everything for him emotionally and in the home.
  5. ISOLATION. The abusive person tries to cut his partner off from all resources. If she has male friends, she's a "whore." If she has women friends, she's a lesbian. If she's close to family, she's "tied to the apron strings." He accuses people who are the woman's supports of "causing trouble." He may want to live in the country, without a telephone, or refuse to let her drive the car, or he
    may try to keep her from working or going to school.
  6. BLAMES OTHERS FOR PROBLEMS. If he is chronically unemployed, someone is always doing him wrong or out to get him. He may make mistakes and then blame the women for upsetting him and keeping him from concentrating on the task at hand. He may tell the woman she is at fault for virtually anything that goes wrong in his life.
  7. BLAMES OTHERS FOR FEELINGS. The abuser may tell his partner "you make me mad," "you 're hurting me by not doing what I want you to do," or "I can't help being angry ." He is the one who makes the decision about what he thinks or feels, but he will use these feelings to manipulate his partner. Harder to catch are claims, "you make me happy," or "you control how I feel.”
  8. HYPERSENSITIVITY. An abuser is easily insulted, claiming his feelings are "hurt," when in actuality he is angry or taking the slightest setback as a personal attack. He will "rant and rave" about the injustice of things that have happened, things that are just a part of living (for example, being asked to work late, getting a traffic ticket, being asked to help with chores, or being told some behavior is annoying).
  9. CRUELTY TO ANIMALS OR CHILDREN. Abusers may punish animals brutally or be insensitive to their pain or suffering. An abuser may expect children to be capable of things beyond their abilities (punishes a 2-year old for wetting a diaper). He may tease children or young brothers and sisters until they cry. He may not want children to eat at the table or may expect them to be kept in their rooms when he is home. Studies indicate that about 60% of men who
    physically abuse their partners also abuse their children.
  10. "PLAYFUL" USE OF FORCE IN SEX. An abuser may enjoy throwing the woman down or holding her down during sex. He may want to act out fantasies during sex where the woman is helpless. He is letting his partner know that the idea of rape is exciting. He may show little concern about whether the woman wants to have sex and uses sulking or anger to manipulate her into compliance. He may begin having sex with the woman while she is sleeping or demand
    sex when she is ill or tired.
  11. VERBAL ABUSE. In addition to saying things that are intentionally meant to be cruel and hurtful, verbal abuse is also apparent in the abuser's degrading of his partner, cursing her, and belittling her accomplishments. The abuser tells her she is stupid and unable to function without him. This may involve waking her up to verbally abuse her or not letting her go to sleep.
  12. RIGID SEX ROLES. The abuser expects his partner to serve him. He may even say the woman must stay at home and obey in all things-even acts that are criminal in nature. The abuser sees women as inferior to men, responsible for menial tasks, and unable to be a whole person without a relationship.
  13. DR. JEKYL/MR. HYDE PERSONALITY. Many women are confused by the abuser's sudden changes in mood. She may think he has some sort of mental problem because one minute he's agreeable, the next he's exploding. Explosiveness and moodiness are typical of men who beat their partners. These behaviors are related to other characteristics, such as hypersensitivity.
  14. PAST BATTERING. The abuser may say he has hit women in the past, but blame them for the abuse ('~hey made me do it"). The women may hear from relatives or ex-partners that he is
    abusive. A batterer will abuse any woman he is with if the relationship lasts long enough for the violence to begin~ situational circumstances do not make one's personality abusive.
  15. THREATS OF VIOLENCE. This includes any threat of physical force meant to control the partner: "I'll slap your mouth off," "1'11 kill you," "I'll break your neck." Most people do not threaten their partners~ abusers will try to excuse their threats by saying "everybody talks like that."
  16. BREAKING OR STRIKING OBJECTS. Breaking loved possessions is used as a punishment, but mostly to terrorize the woman into submission. The abuser may beat on the table with his fist, or throw objects around or near his partner. Again, this is remarkable behavior. Not only is this a sign of extreme immaturity, but there is great danger when someone thinks he has the right to
    punish or frighten his partner.
  17. ANY FORCE DURING AN ARGUMENT. This may involve the abuser's holding the woman down, physically restraining her from leaving the room, or any pushing or shoving. He may hold his partner against the wall, telling her "You're going to listen to me!"

Protecting Your Children in the Court System

A mother who spent a decade trying to protect her daughter from her abusive ex shares her advice
Protecting Your Children in the Court System
Maralee Mclean is a survivor in every sense of the word. After living through a marriage to an abusive man, she lived through a custody battle with her ex-husband after he was accused of sexually abusing their 2-year-old daughter. He won.

Even though multiple police and hospital reports confirmed the abuse occurred, Mclean says her ex was able to manipulate the court system to his advantage. Says Mclean, “The family courts are failing, and failing miserably.”

For a decade, Mclean fought for custody and to protect her daughter. She wrote a book about her journey, Prosecuted But Not Silenced: Courtroom Reform for Sexually Abused Children. Says Mclean about her ordeal, “You may be emotionally and financially depleted, and the heartbreak may be overwhelming, but never ever give up. This was a nightmare no mother would want to endure but we are doing well today. I am an activist and she is a survivor.”

In her book, Mclean shares tips for parents on protecting their children while in the court system, specifically when dealing with domestic abuse or child sexual abuse. Below, some of the things she hopes all parents facing the justice system with their children could know.
  • Hire a good attorney. This might go without saying, but you need one who has experience in the proceedings of child sexual abuse cases and who knows that civil court will make it into a custody issue versus a sexual abuse issue, explains Mclean. “Most family law attorneys do not have the information required to litigate these cases. This will take a lot of work on your part by looking on the Internet for an attorney who works on domestic violence and child abuse cases. Make the phone calls and get in the door for an appointment,” she writes.
  •  If you can’t afford an attorney, you may be able to find someone for free. Domestic violence shelters near you should be able to refer you to local legal aid attorneys who could take on your case pro bono. “You must have your facts in order and more or less plead for help,” writes Mclean.
  •  Educate yourself. Read up, advises Mclean. Study what is happening in similar types of cases and see if it can be applied to your own.
  •  Do not run. “This is not the answer for your child and will be doing more damage,” writes Mclean. 
  •  Stay as calm as you can. “Follow all court orders and rules no matter how outlandish they become, and keep it together,” advises Mclean. 

  •  Document everything. “I suggest getting a legal binder organized with hearings, dates and times when motions were filed—all correspondence. Make sure this binder explains your case. If you have therapy reports, police reports, doctor reports, hospital reports with abuse information or physical evidence, place all of it in sequential order. You need to be your child’s number-one advocate so you can present professionally what is happening in your case,” writes Mclean. 

  •  Don’t speak for your child during an examination. If a medical examination is required for your child, it’s important you refer to your child, if old enough, to answer for him or herself. “[The courts] will say you coached your child if you answer for them,” explains Mclean.
  •  Maintain a routine. Whenever possible, keep your child in his or her same surroundings and schools, near family and friends they’re familiar with. They need some normalcy.
  •  Affiliate yourself with people of influence. “You are the one on trial, so affiliate yourself with as many organizations as you can. Go to your senators, congressman, the governor, and do not be afraid to state what is happening to your child and how it is being handled in the courts,” writes Mclean.
  •  Stay neutral. Mclean says, unfair or not, showing too much emotion in court can make you seem unstable, and not showing enough emotion will make you seem uncaring.  
  • Supervised visits are hard, but always go. Mclean knows firsthand the emotional toll supervised visits will take on a parent, and if you’re the one ordered to undergo them, stay in them no matter what. Otherwise, she warns, the courts could end your parental rights. “Make it a great hour and think quality time is precious time.”
  •  Take care of yourself. “Try to emotionally and physically surround yourself with a support system of family and friends. This is a nightmare … let your child see your strength.” She also advises parents to look to their spiritual side for comfort. And, if suicidal, get help. “Be aware the healthier you are, the more you can do to free your child from this nightmare. This will be difficult, and maybe unbearable, but in the end, you will be proud that you stood up for your child and made a difference in the world.”
Finally, writes Mclean, “Love, love, love with all your heart and soul.”

Person Centered Therapy

Person Centered Therapy




Theoretical Foundations

■ Focus is on the person and not the presenting problem

Humanism

o Philosophical movement that emphasizes worth of the individual and the centrality of human values
o Attends to matters of ethics and personal worth
o Gives credit to the human spirit
o Emphasis on creative, spontaneous, and active nature of humans
o Optimistic
o Human capacity to overcome hardship and despair

Non-Deterministic

o Beliefs that it is oversimplification to view people as controlled by fixed physical laws.
o Encouragement of therapy that considers individual initiative, creativity, and self fulfillment

Self Actualization

 o Innate process by which a person tends to grow spiritually and realize potential

The Experiencing Person

o Important issues must be defined by the client
o Special concerns are discrepancies between what a person thinks of himself and the total range of things he experiences

Techniques

■ Listening
■ Accepting
■ Respecting
■ Understanding
■ Empathic Responding

Monday, July 18, 2016

Potential Ethical Violations



YAVIS- Counselors tend to prefer clients who are young, attractive, verbal, intelligent, and successful, but the most influencing factor is similar cultural backgrounds and experiences.

Viewing clients from the counselors perspective
o The following can be misinterpreted as “problems” in counseling, causing the therapist to see the client as resistant or non-responsive

  • ■ Silence
  • ■ Lack of eye contact
  • ■ Deference to authority

o Client defensiveness or non-disclosure may be termed “healthy cultural paranoia”

  • ■ For many clients the majority cultural environment is hostile and therefore a defensive stance is a rational response.
  • ■ The counselor must acknowledge that the problem may not lie in the client but rather the environment in which the client lives as a minority member


Stereotyping clients by group
o May be unintentional in that the counselor researches the “group” and what the group beliefs are according to research but in so doing generalizes and may miss something about the individual sitting in front of them.

Inappropriate Selection of techniques
o Counselors often depend on high level of verbal exchange to achieve therapeutic progress.

Inappropriate Selection of Tests and Measurements
o Many test reviews have only been done on the majority population type and may not be applicable to all cultures, skewing “normal” results.
o There should be an investigation of possible differences in validity for ethnicity, sex, or other sub-samples that can be identified when test is given.
o What is considered an objective assessment instrument within a majority culture may not be so within a minority culture or a different cultural orientation.
o It is an ethical duty to be aware of this research prior to administering assessments.



Sunday, July 17, 2016

Assessments in Family Therapy

Self-report scales




■ Cost effective to administer

■ Provide information on how family members evaluate their own functioning.

The Dyadic Adjustment Scale (DAD)
■ 32-item measure of marital quality and marital adjustment
■ Four subscales measure

  • • marital satisfaction
  • • cohesion
  • • consensus
  • • affective expression
■ The Family Environment Scale (FES) is a 90-item true/false measure assessing how family members perceive their family environment along the three domains of relationships, personal growth and system maintenance.

■ The Family Questionnaire (FQ)
o Brief measure of perceived criticism and overinvolvment.

■ The Family Assessment Device (FAD)
o 60-item scale that assesses the six dimensions of the McMaster Model of Family Functioning

  • ■ Communications
  • ■ problem solving
  • ■ affective responsiveness
  • ■ affective involvement
  • ■ roles
  • ■ behavior control

Interview-based family assessment instruments

■ More labor intensive and require rater training.

■ Provide an outside perspective on how a family functions compared to other families.

■ The Camberwell Family Interview o Requires extensive training
o Used to assess levels of criticism and overinvolvment.

■ The Five Minute Speech Sample o Method of assessing expressed emotion in relatives of patients with psychiatric disorders.

■ The McMaster Clinical Rating Scale (MCRS) o Based on a family interview conducted by a rater
o Assesses the same six dimensions of family functioning as the FAD in addition to assessing the overall health/pathology of a family.
o Inter-rater and test-retest reliability as well as concurrent and discriminative validity.
o Can take from 45 to 90 minutes depending on the experience of the rater.


Family Therapy for Childhood and Adolescent Disorders

■ Family Risk and Protective Factors
 o Childhood and adolescent behavior problems have been strongly and consistently linked to a number of family factors, such as conflict and aggression.
o Longitudinal studies show that ineffective parenting practices in childhood maintain antisocial behavior into adolescence.



■ Family based interventions for child behavioral problems
 o Various family therapy approaches specifically target the coercive family patterns maintaining behavior problems while at the same time bolstering protective factors in the family and other systems that have an impact on the child.

■ Engagement and Retention Therapy
 o One of family therapy’s major contributions is an increased focus on strategies for engaging difficult youth and their families in treatment

■ Parent Management Training
o Focusing on the parent in treatment
o Helping parents identify, observe, and react to the child’s problem behavior in new ways
o Applying social learning principles to increase parenting skills to shape the child’s behavior.
o Providing opportunities to practice new parenting skills and apply them in the home.

■ Functional Family Therapy
 o This model is based on the assumption that children’s behavior problems serve a function within the family system and are initiated and maintained by maladaptive interpersonal processes.
o Treatment targets change in these destructive interactional patterns and uses behavioral interventions to reinforce positive ways of responding and to establish more effective problem-solving

■ Multisystemic Therapy
 o Several different models have demonstrated efficacy and are generating evidence of effectiveness community-based replication studies.
o These therapies promote positive outcomes such as more pro-social peer relationships and family functioning, as well as reducing conduct problems.


Risk factors for and patterns of abuse



Recognizing sings of abuse
In the child:
o Sudden changes in behavior or school performance
o Not medical attention for problems brought to parents attention.
o Learning problems, difficulty concentrating, that cannot be attributed to specific disabilities.
o Tends to be watchful, expecting something to happen.
o Lacks adult supervision.
o Overly compliant, passive, or withdrawn.
o Comes to school or other activities early, stays late, does not want to go home.

The Parent:
o Shows little concern.
o Denise existence of, or blames the child, for problems at school or home.
o Asks teachers to use physical discipline.
o Describes child as bad or burdensome.
o Demanding high levels of academic and physical performance.
o Relies on child for care, attention, emotional needs.

Parent and Child:
o Do not look or touch each other.
o View of relationship is only negative.
o State they do not like each other.


Pattern of Abuse
Tension building 
o Anger builds.
o Poor communication.
o Victim feels the need to keep the abuser calm.
o Tension mounts.
o Victim constantly feels weary of abuser.
o Abuse (physical, emotional, or sexual) takes place.
Making up:
o Apology may be made.
o Promise of the last time.
o Victim blaming.
o Denial of abuse.
o Calm
o Abuser acts as if nothing has happened.
o Some promises may be met, during this time.
o Victim may believe the abuse is truly over.
o Abuser may give gifts to victim.

Saturday, July 16, 2016

Adopting Parents



■ The idea of adoption has changed over the last few decades from a last resort to a natural option in creating a family.

■ With the ease of travel many adoptions are from outside the US, blending not only a new family but also cultures and races as well. (known as transracial and transcultural adoption).

■ Adoption occurs for many reasons, such as the wish to expand families or to provide a home for children in need.

  • o Kinship adoption may include grandparents adopting the children of their children.
  • o More single people of both genders are adopting today than ever before, as are gay and lesbian couples.


■ The Decision to Adopt

  • o If the choice is motivated by infertility many issues can accompany the choice.

◆ Feeling of loss
◆ Feeling of giving up on a dream
◆ Anxiety and fear about making this decision
◆ Stress related to how to go about adoption, how society will impact their decision, how their families and support systems will react.

  • o The paper work alone can be overwhelming
  • o Stress may affect a marriage if couples have different coping skills or if one is more ready to adopt than the other.


■ Foster Children

  • o Being able to provide the appropriate medical, emotional, or academic support for foster children with special needs.
  • o Prepared to suffer the potential loss of the relationship if child is returned to home or adopted by another family.
  • o Stress of how to handle the child’s biological parents and family.


■ Parenting Adopted Children
o Address children’s questions about their adoption, about birth parents, and be able to prepare child for questions by others about their adoption.
o Any parent has to be aware of changes in behaviors that indicate an emotional struggle, such as:

  • ◆ Social withdrawal
  • ◆ In attentiveness that affects productivity at home or school
  • ◆ Anger outbursts and temper tantrums
  • ◆ Attachment anxiety, fear of being alone
  • ◆ Changes in eating or sleeping patterns.


■ Role of Family Therapists

  • o Help the family understand the impact of adoption on the family and the child
  • o Work with the children who may have a hard time talking to adoptive parents about the adoption fearing it might show a sign of disloyalty or being unappreciative.
  • o Normalizing the feelings of wanting to learn about their biological parents and the reasons why they were put up for adoption.
  • o Work with the biological children in the family giving them a place to explore their feelings about the adoption.
  • o With the adjustment to new relationships, the family therapist can ensure positive communication and creating appropriate boundaries to benefit the children and strengthen the family.




SocialWorkExam.com offers online prep for NASW. Unlimited access to practice exams, case studies, simulations, video, audio, and flash cards 24/7.


■ The idea of adoption has changed over the last few decades from a last resort to a natural option in creating a family.

■ With the ease of travel many adoptions are from outside the US, blending not only a new family but also cultures and races as well. (known as transracial and transcultural adoption).

■ Adoption occurs for many reasons, such as the wish to expand families or to provide a home for children in need.

  • o Kinship adoption may include grandparents adopting the children of their children.
  • o More single people of both genders are adopting today than ever before, as are gay and lesbian couples.


■ The Decision to Adopt

  • o If the choice is motivated by infertility many issues can accompany the choice.

◆ Feeling of loss
◆ Feeling of giving up on a dream
◆ Anxiety and fear about making this decision
◆ Stress related to how to go about adoption, how society will impact their decision, how their families and support systems will react.

  • o The paper work alone can be overwhelming
  • o Stress may affect a marriage if couples have different coping skills or if one is more ready to adopt than the other.


■ Foster Children

  • o Being able to provide the appropriate medical, emotional, or academic support for foster children with special needs.
  • o Prepared to suffer the potential loss of the relationship if child is returned to home or adopted by another family.
  • o Stress of how to handle the child’s biological parents and family.


■ Parenting Adopted Children
o Address children’s questions about their adoption, about birth parents, and be able to prepare child for questions by others about their adoption.
o Any parent has to be aware of changes in behaviors that indicate an emotional struggle, such as:

  • ◆ Social withdrawal
  • ◆ In attentiveness that affects productivity at home or school
  • ◆ Anger outbursts and temper tantrums
  • ◆ Attachment anxiety, fear of being alone
  • ◆ Changes in eating or sleeping patterns.


■ Role of Family Therapists

  • o Help the family understand the impact of adoption on the family and the child
  • o Work with the children who may have a hard time talking to adoptive parents about the adoption fearing it might show a sign of disloyalty or being unappreciative.
  • o Normalizing the feelings of wanting to learn about their biological parents and the reasons why they were put up for adoption.
  • o Work with the biological children in the family giving them a place to explore their feelings about the adoption.
  • o With the adjustment to new relationships, the family therapist can ensure positive communication and creating appropriate boundaries to benefit the children and strengthen the family.




SocialWorkExam.com offers online prep for NASW. Unlimited access to practice exams, case studies, simulations, video, audio, and flash cards 24/7.

Adoption

Impact on Birth Parents

o Grieving the Loss of the Child. - Sense of loss.
- Loss of immediate life plans.
- Most struggle with the decision to place the child for adoption; those who decide to do so begin to plan for a great loss in their own lives with the hope that placing the child for adoption will result in a better life for their baby and for themselves.
- Trauma can be impacted by the process, lack of support, the behavior of the adoption agency, or level of communication with adopting family.
- Clients often express feelings of numbness, shock, and denial, as well as grief.

o Normalize these as typical reactions to loss. - An added struggle with this type of loss is the greater sense of privacy around it which may limit help from support systems who may not be informed.
- Due to the secrecy, this loss often lacks typical cultural rituals or ceremonies to gain closure.

o Grieving Other Losses. - Loss of parenting role.
- Feelings of loss may reoccur during holidays, anniversaries or birthday.
- Stress of pregnancy and adoption may take a toll on the partner/marital relationship.
- If client is young, this may also cause a significant issue in parental relationships.
- If young, the client my have to drop out of school.

o Guilt and Shame. - Societal values often show a lack of understanding over the circumstances leading up to adoption.
- Culturally, there is an association of shame with unplanned pregnancy.
- Client may express feelings of unworthiness.
- Clients who discuss their feelings with supportive friends, family, or counselors may more easily come to terms with their decision over time and be able to integrate the experience into their lives in a healthy way.

o Identity Issues. - Clients often ask themselves if they are “parents”.
- Some mothers may experience a sense of incompleteness after giving birth.
- Parent status is not acknowledged by society, family, or friends for those who give up children for adoption.
- The issue of being involved in the child’s life and how to integrate with the adoptive family is an important one.

o Long-Term Issues. - Feelings about the adoption may be life long, but varying in intensity.
- Some of the factors that have been found to be associated with longstanding grief include:
⋄ A birth parent's feeling that she was pressured into placing her child for adoption against her will
⋄ Feelings of guilt and shame regarding the placement
⋄ Lack of opportunity to express feelings about the placement
- For some birth parents, the ability to establish a successful marriage or long-term relationship may depend on the openness with which they can discuss their past experiences of birth and adoption placement.
- Some birth parents never tell their spouses or subsequent children of their earlier child.