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Assessment
does not end when intervention begins; continues throughtout contact with client
First priority in treatment
SAFETY!!
The Helping Process
1. relationship building, exploration, engagement, assessment, planning
2. implementation and goal attainment
3. termination, planning maintenance strategies, evaluation
Types of Crises
1. situational
2. maturational: development based crisis
3. crisis due to cultural values or societal factors
Goals of Crisis Intervention
1. reduce immediate impact of crisis
2. help client mobilize, gain resources, develop better coping skills
3. return to pre crisis level of fx
If crisis is experienced as...
threat: increased anxiety
loss: depression, feelings of deprivation, mourning
challenge: moderate anxiety, hope, positive expectations
Stages of experiencing crisis
1. crisis
2. increased tension, shock, poss denial, coping skills fail
3. sharply escalating tension, overwhelmed, confused, helpless, hopeless, poss depression
4. try to use different coping skills--adaptive? maladaptive?
Two Uses of Communication Techniques
1. intervening with client: therapist should be the best communicator
2. teaching client: therapist should model good skills
Use the therapeutic relationship to...
1. help pt make sesne of info, feelings, responses, memories
2. help pt make a plan to deal with problems that have been created
Cultural differences
~be aware of them in selecting communication methods
~obtain an interpeter if English not primary language, pref from pt's culture
Verbal Following Skill: Seeking concreteness
~assist pts in discussing experiences in concrete terms
~clarify vague or unfamiliar terms
~help pt "personalize" communications: e.g. use "I" or "me" when talking re: experiences, thoughts, emos
~ID specific feelings, focus on here and now, express detail of experience
Components of Effective Confrontation
1. must support tx goals, meet pt needs
2. appropriately timed: closely after event, w/enough time to process after
3. tx r'ship must be strong enough
4. specific in nature
5. pt-based, not time for therapist to vent hostility
Barriers to Communication Secondary to Pt Characteristics
1. pt fearful of therapist response
2. denial, minimizing
3. fear of losing control
4. pt feels responsible for their situation
5. projection of past discrimination or neg interactions
Barriers to Communication Secondary to Therapist Chacteristics
1. therapist is too passive or aggressive
2. excessive interruptions > pt feels not important
3. providing premature assurance, untimely advice > stop talking before adequate depth of tx achieved
4. poor wording: repeating exact words, sarcastic comments, poor humor, guilt producing language
5. nonverbal communication: bored, annoyed, etc.
Viewing pt as an individual
1. thoughtfulness
2. privacy
3. remember details of case
4. flexibility; adjusting tx goals and interventions as needed
Purposes of client expression
1. reduce burden pt is feeling > see problems more clearly, therapist provides support
2. greater depth of understanding, feelings re: issues
3. therapist can see if negative feelings are problems, need to be tx goal
4. strengthen r'ship, disclose more fully
Limitations to expression of feelings
1. too early: embarassed, leave tx
2. reveal too much, agency gives short term tx
3. uncontrolled hostility at worker: understand, not encouaraged
Ethical Issues within the R'ship (from NASW)
1. help those in need, address social problems
2. respect dignity, worth of person
3. recognize importance of r'ships
4. bx in trustworthy manner
5. respect, promote rights of pts to self-determination; assist pts to ID, clarify goals
6. respect right to privacy
7. no rude language to, re: clients--verbal or written
8. understand, find strength in each culture
Social Worker and Client Roles
1. broker: assist pt in locating resources, or makes referrals
2. case manager: assess pt needs, ensuring pt obtains needed resources
3. mediator: ID barriers to pt receiving aid > help pt remove barriers
4. client advocate: help pt access resources she would otherwise be unable to access
Pt's Stated Goals
whenever possible, should be the primary goal of tx
Crisi Intervention: Anticipatory Guidance
preventive measure that prepares pts fo rdealing with stresses and crises by planning coping strategies to use in those situations
Social Role Theory: Social and Invidual Determinants of Role Bx
person's needs; person's ideas of mutual obligations, expectations that have been invested in the particular status he undertakes; compatibility or conflicts between person's conception of obligations and expectations and those hold by the other person with whom he is in a reciprocal r'ship
Social Role Theory: Failure in Role Complementarity
cognitive discrepancy; discrepancy of roles; allocative discrepancy; absence of instrumental means; discrepancy of cultural value orientation
Social Role Theory: Role Allocation
¤ascribed: automatically by age, sex, etc.
¤achieved: by occupation
¤adopted: satisify some need of the individual
¤assumed: "let's pretend"
Social Role Theory: Sanctioning
bx w/intent of modifying another's bx, usually toward conformity
Social Role Theory: Locus of Control
extent to which a person believes that life events are under her own control (internal) or under the control of outside events (external)
Bases of Social Power
¤coercive: control of punishments
¤reward: control of rewards
¤expert: superior ability or knowledge
¤referent: standard for self-evaluation; likeability; attracted to or identifies w/person w/power
¤legitimiate: having legitimate authority
¤informational: content of message leads to new cognitions
Strenghts Perspective: Strengths in Context
appropriate coping in one context may not be in another; having variety of coping skills enables flexibility in the way one copes w/stress
Resilience
Traits Related to Resilience
¤social competence
¤autonomy
¤problem solving
¤sense of purpose and belief in the future
Cognitive Dissonance Theory
¤Person has to choose btwn 2 contradictory attitudes and beliefs
¤Reduce by
1. reduce importance of beliefs
2. acquire beliefs that change the balance
3. remove the conflicting attitude or bx
Helper, Helpee Objectives
¤helper's perceived objective is to help
¤clarification, def of these objectives is often important part of the healing process
¤each person has certain degree of power
Intervention Least Likely to Cause Harm
empathic response is the least likely of all interventions to cause harm to a pt
Farmer Aladdin Raises Expensive Apples From India
Feelings - acknowledge clients
Assess
Refer
Educate
Advocate
Facilitate
Intervene
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