Feedback Loops in Clinical Practice: An Integrative Framework

Practical concepts and interventions for counsellors and their clients are presented based on Maruyama's concept of feedback. Elements of psychodynamic theory, Weinberg's theory and Moreno's role theory are reformulated in terms of feedback. The concept of feedback also links network theory and chaos theory; cognitive challenges and psychodynamic interpretation. This forms an integrative framework for understanding human functioning. Human functioning emerges from the interaction of innumerable intrapersonal and interpersonal feedback loops. The feedback loops organise a network of actions, ideas and feelings, and a network of roles. Some feedback loops tend to intensify life difficulties, while others tend to resolve these difficulties. The counselling interventions evolved from problem‐gambling counselling practice, and sample interventions are provided based on a composite problem gambler.     

The Integrative Case Analysis Model for Linking Theory and Practice

This article introduces a case analysis model and field seminar format developed to enhance students' abilities to systematically integrate theory and practice in relation to their work with practicum clients. The authors draw upon learning theories and empirical research to explain the utility of the model and then describe specific components of the field seminar format including structured student assignments, associated classroom pedagogy, and an evaluation plan. The authors discuss the feasibility of implementing this model and offer considerations for further research.     

Community-Centered Clinical Practice

Abstract

There has been a longstanding tension between the domains of micro and macro practice in social work practice and academic programs. A set of structural and interpersonal tensions can be identified as interfering with accurate perceptions of the underlying continuity of social work practice that is reflected in the mission of the profession. This analysis addresses this tension by defining the elements needed for the integration of micro and macro practice in the form of community-centered clinical practice. A set of cross-over skills are identified along with recommendations for improved agency operations and professional education related to the integration of micro and macro social work practice.     

Integrative Family Therapy With Childhood Chronic Illness: An Ethics of Practice

A challenge for contemporary family therapists is negotiating differences between modern and postmodern frameworks in the practice context. Modernists espouse a systemic metaphor; use evidence‐based and interventive approaches, including strategic, structural‐ or solution‐focused techniques, and believe in the therapist's knowledge, expertise and power to influence individuals or families to change. On the other hand, postmodernists follow a social constructionist, dialogical or narrative paradigm, which identifies the main ingredient of therapy as language, conversation, understanding and the therapist's ‘not knowing’ stance in eliciting a person's expertise and story Yet many practitioners adopt a middle way between these paradigm polarities, one that is less theory‐driven and more pragmatic, flexible, integrative and practice‐based. This is consistent with evidence‐based practice and research demonstrating common factors across all therapies. The value of preserving systemic thinking in family therapy is recognised while reaching forward to a postmodern social constructionist and dialogical approach. The article describes this integrative stance in family therapy as paramodern based on an ethics of practice. This is illustrated by a detailed case study of integrative family therapy, which addresses anxiety, anger and sleeping issues associated with a chronic childhood illness called Perthe's disease.     

Contributions and Challenges to Clinical Practice from Buddhist Psychology

Psychotherapy is considered to belong to a branch of medicine, and adheres to many conventions of the medical model. As psychotherapists continue to embrace mindfulness (a foundational practice derived from Buddhist psychology), the way we understand suffering and what is to be done about it may be informed by the insights gained in mindfulness practice. Some of these insights depart in degree and in type from the assumptions underlying the medical model, as well as from prevalent ideas of suffering, treatment, and most challenging, the idea of the self who is assumed to be at the center of suffering. By examining a number of influences of mindfulness on clinical practice, the author suggests subtle and potentially radical influences on the way we think of the healing process. It is hypothesized that the Buddhist model may offer a transtheoretical and transcultural model of suffering and its treatment.     

Unforeseen Implications of Regulation to Authenticity in Clinical Practice

The authors, both long-time LCSWs, utilize an existential framework and postmodern lens to explore the implications of increased professional regulation in clinical practice. Specifically emphasized, are the themes of litigation-fear and the threat of license revocation that are prevalent in the field of clinical social work at this time. The authors argue that this “climate of fear” can lead to a slippery slope for a profession that has long valued the individual’s right (both client’s and practitioner’s) to self-determination, authenticity, and creativity and call for an increased conversation among practitioners about the desired role of regulation in the profession with the overall goal of protecting a true understanding of ethics in social work.     

Transitions to Systemic Practice for a Clinical Psychology Trainee

This article provides an individual perspective on encounters with systemic and family therapy ideas during the transition from university training to professional practice as a Clinical Psychology Registrar. Clinical psychology training provides a solid grounding in individually focussed, cognitive and behavioural models of psychotherapy. What may be less developed on entry to practice are the knowledge, procedural skills and reflective competencies needed to understand and respond to challenges in family‐based therapy and in working within complex caregiving systems. Systemic ideas can provide important resources for facilitating these transitions. Trainees may need support not only in gaining knowledge of family therapy models, but also in making a challenging ‘epistemological shift’ (Cullin, 2014) from internalised models of psychopathology to systemic ways of thinking about problems and change. Systemic concepts and support in developing a position of ‘hospitality’ (Larner, 2003) towards competing therapeutic models can also help the trainee be more effective in complex caregiving environments. This article provides examples from my learning as well as reflections on what may help trainees make the transition to professional practice and make use of systemic ideas.     

Approaches to child abuse

Abstract

The officially decreed procedure for preventing child abuse does not do so. Three reasons stand out, any one of which would account for this:

Investigations are based on asking the wrong questions. As a result many children are removed unnecessarily, while others do not get the protection they need.

The method of managing cases is seriously flawed. In particular, there is failure to put one person in charge, with full authority to direct the case, and sole responsibility for its outcome. Case conferences, at-risk registers, and some fashionable treatment procedures, are incompatible with a rational solution.

Social workers, without adequate help and support, are required to perform a task for which most are not equipped, and according to instructions that make it impossible. Their training no longer endows them with skill in psychotheraputic casework, and they do not thereafter receive regular supervisory counselling, both of which are indispensable for helping disturbed clients. Moreover, fieldworkers are expected to make decisions that should be the responsibility of the supervisor.     

Life Participation Approaches to Aphasia

ABSTRACT

This paper discusses a recent development in aphasia treatment, termed the Life Participation Approach to Aphasia (LPAA) (Chapey et al., 2001). LPAA is a model of aphasia rehabilitation that is being practiced internationally in Canada, Australia, England, and the United States. This approach is consumer-driven, and emphasizes reengagement in life. LPAA views family members and the larger community as active contributors to the rehabilitation process. Rather than focusing on the hypothetical situations depicted in pictures, real-life social interactions comprise the therapy context with LPAA.     

Wise Approaches to Common Problems

Abstract

Grayson PA, Meilman PW, Beating the College Blues New York: Facts On File; 1992. Paper. 231 pps, $12.95. Reviewed by Raymond Babineau.     

Creating Synergy in Practice: Promoting Complementarity Between Evidence-Based and Postmodern Approaches

Postmodern and evidence-based practice (EBP) are compared and contrasted with the primary aim of adapting evidence-based practice with a more flexible epistemological lens. We begin by reviewing the epistemological underpinnings of postmodern and EBP within the field of marriage and family therapy (MFT). We next discuss how these contrasting philosophies inform therapists’ traits and practice in the context of translational research and practice-based evidence. Finally, we point toward some promising directions for a flexible adaptation of evidence-based practice in which both modern and postmodern clinicians can practice, and ways to incorporate some of these more flexible principles into the clinical training of MFT students.     

An Integrative Approach to Teaching Family Resource Management

Abstract

Family resource management is one of ten substance areas that are required for certification in family life education (National Council on Family Relations, 2005). Unfortunately, few discipline-specific resources are available for faculty assigned to teach the family resource management course. A rich tradition of theory and practice in the field has stalled, with little conceptual development since the 1980s to guide faculty teaching the course. In response, we offer a new conceptual framework for teaching family resource management that extends previous models by integrating management with other functions of the family. Specific course objectives, methods of evaluation, classroom activities, recommended materials, and teaching strategies are provided.     

Utilizing International Clinical Practice to Build Inter-Cultural Sensitivity in Social Work Students

ABSTRACT

This paper describes an international clinical internship that uses a developmental model to build inter-cultural sensitivity in baccalaureate social work students. The paper analyzes the stages students go through as they struggle to develop a bi-cultural professional perspective. This model adheres to the position that cross cultural practice in a multicultural world not only conforms to the emerging picture of life in the United States, but is also in accord with the values of social work.