A Cognitive Approach to Direct Practice with the Aging

The recent prominence of cognitive approaches in psychotherapy and more recently in social casework holds considerable promise for direct practice with olderpersons on both an individual and group basis. Several central concepts in cognitive theory are delineated and found to have particular advantages for the aging. First, they deal with conscious concerns and avoid the dangers of affective or regressive approaches in breaking down defenses. Second, they are heavily concerned with questions of meaning and self-concept, issues that are central to the last stage of life, as delineated by Erikson, and the task of achieving ego integrity over despair. Two case illustrations of the application of a cognitive approach in a group context are given.     

Paternal domination: Its influence on child guidance results 1

Acknowledging the limitations of adhering to one particular theoretical orientation in helping clients with multiple issues, psychotherapy integration in treatment becomes a prominent trend in clinical practice. However, we have few guidelines for an integrated case formulation. Also, there have been some concerns that available treatment options limit and even pre-determine how clinicians understand and formulate cases. In order to address these concerns, this article first critically reviews the psychotherapy integration movement and highlights social work contributions to this movement. Next, using a clinical case example, we illustrate an integrated case formulation in clinical social work practice, which comprehensively assesses a client-in-context from psychodynamic, behavioral, and cognitive approaches. We also delineate how social workers can directly link this integrated assessment to selecting the integrated treatment options to custom-fit with the idiosyncratic needs of the client. This formulation is then truly client-centered. Thus, formulating a case is developing a theory of a client.     

Abstracts of theses: Smith college School for social work 1945

Abstract

This paper examines various psychoanalytic conceptions of trauma, including ideas associated with classical psychoanalytic theory, object‐relations theory, self‐psychology and continuous construction theory. Clinical issues germane to the psychotherapy of children are then discussed and a clinical vignette presented. The vignette focuses upon the psychotherapy of a 10‐year‐old boy, with particular attention given to the narrative discourse that evolved in the course of the boy's therapy. The evolution of the child's narrative is illustrated through the use of transcribed material derived from different phases of the boy's treatment.     

论专业宣传实务活动中的“镜中我”效应

自我观念是通过社会化形成和发展的,库利的镜中我理论清楚的阐述了自我发展的阶段。目前在中国大陆社会工作专业发展处于“开荒种田”的状态,容易导致专业学生尤其大一学生产生专业自我观念难以确定的困惑,会视自己为专业的牺牲者、旁观者和路过者。而开展积极的专业宣传实务活动正是解决这一问题的有效途径和方法。通过专业宣传实务活动,让学生走入社会,在社会互动的镜子中塑造正确的专业自我观念,激发专业自信,实现专业认同。     

GROUP WORK WITH ALCOHOLIC,POLY DRUG-INVOLVED ADOLESCENTS WITH DEVIANT BEHAVIOR SYNDROME

Trail-blazing efforts are now underway in social work treatment with adolescents who are involved with both alcohol and other drug abuse and who have been arrested for antisocial acts. These are young people who are caught in a pathological system which is spiraling them deeper and deeper into self-destruction, either by their antisocial acts leading to continuing conflict with the law and often incarceration, and/or to the breakdown of their physical system by the substance abuse. Traditional forms of social casework or psychotherapies are of little use since the young person is likely to deny vigorously that he has a problem and shrink from contact with the helping resources that are available. Whereas a psychodynamic orientation is necessary in order for the worker to provide the degree of understanding of the internal turmoil of these young persons, the focus of treatment must be upon problem solving and a peer support system that can sustain the faltering ego through the social hazards of adolescence and young adulthood. To understand the professional demands of this practice, we will describe the general characteristics of this special segment of today's youthful population, the social-psychodynamic factors involved, and the diagnostic issues raised. Several concepts for clinical practice with these young people will be discussed: enforced treatment, age-related differential planning, and group work as the optimal treatment modality. An actual group work practice situation will illustrate theorerical and technical issues raised in the treatment process.     

Being the Only One: Finding Connection through the Shared Experience of “Otherness”

ABSTRACT

There is a noticeable paucity of clinical resources that help clinicians of color to name and navigate the multitude of challenges in working through racial, cultural, and power differences in psychotherapy with White clients. African American therapists rarely receive adequate preparation for clinical practice in identifying, addressing, and working through transference and countertransference reactions in racially mixed dyads. The author highlights the challenges she faced early in her career with addressing racial and sociopolitical differences as an African American female clinical social worker providing individual psychotherapy to her older White male client whose traumatic experience focused on racial issues.     

Five cases illustrating the possibilities and limitations of indirect treatment of problem children 1

Most of the published literature on disability determination focuses on prevalence, applying for benefits, or sociodemographics. There is a paucity of literature that addresses the impact on treatment when a clinician is asked to contribute to a disability determination in the midst of an ongoing psychotherapy. In addition, the clinical literature is primarily written by and for psychiatrists. Yet a disability determination during psychotherapy is at the heart of clinical social work practice when it attends to the patient’s environment by offering help with material needs, while simultaneously providing relationally based treatment.     

小组工作介入大学生自我同一性成长实务探析——以武汉理工大学“扬帆远航”自我同一性成长小组为例

本文以扬帆远航自我同一性成长小组为例,探讨小组工作如何提高大学生的自我同一性发展水平。促进自我同一性发展的关键是获得关于自我的知识和整合感,能对未来发展做出正确的选择。在小组中,获取自我知识的方法主要有他人回馈、社会比较、社会角色的扮演及自我探索。自我的整合则是通过形象整合和生涯规划来实现。工作者对小组进行了科学的设计,采用六个同一性地位作为评估成员自我同一性发展水平的标准,小组目标和内容的确定充分考虑成员需求,科学设计小组会期。对小组的评估显示,绝大多数成员的自我同一性水平有了较大提高。     

Stop,Look, and Listen: Being a Child Psychotherapist

Therapeutic stance, attention to process, and empathic connection represent crucial dimensions of effective child psychotherapy. These concepts are explored with illustrative composite case vignettes, drawn from clinical practice in child psychotherapy and classroom consultation. When clinical treatment adequately integrates stance, process, and connection, patients engage forward development with enhanced capacities to play, work, and relate.     

小组工作介入大学生自我同一性成长实务探析——以武汉理工大学“扬帆远航”自我同一性成长小组为例

本文以"扬帆远航"自我同一性成长小组为例,探讨小组工作如何提高大学生的自我同一性发展水平。促进自我同一性发展的关键是获得关于自我的知识和整合感,能对未来发展做出正确的选择。在小组中,获取自我知识的方法主要有他人回馈、社会比较、社会角色的扮演及自我探索。自我的整合则是通过形象整合和生涯规划来实现。工作者对小组进行了科学的设计,采用六个同一性地位作为评估成员自我同一性发展水平的标准,小组目标和内容的确定充分考虑成员需求,科学设计小组会期。对小组的评估显示,绝大多数成员的自我同一性水平有了较大提高。     

Shared Spaces: An Intersubjective Case Study of a Graduate Student by a Graduate Student

The intersubjective therapeutic experience creates a shared space within which client and therapist are affected and changed, as seen in a psychotherapy case involving graduate students and a graduate student clinician. Analysis of a clinical case composite from an intersubjective perspective is the primary tool used to examine client–therapist concurrent graduate work. A composite is used to protect confidentiality. Several themes are explored: anxiety, perfectionism, and socioculturally situated life stage. As a search of the literature revealed no previous work on the intersubjective experience of psychotherapy when client and therapist are engaged in concurrent graduate work, further exploration is encouraged.     

叙事心理治疗在社会工作中的应用

叙事心理学是在后现代心理学思潮影响下兴起的一种新的研究取向。叙事心理治疗在社会工作运用,需要社会工作者能够建立良好的关系,耐心倾听故事叙说,在咨询中将问题外化,形成积极有力的自己观念。     

叙事心理治疗在社会工作中的应用

叙事心理学是在后现代心理学思潮影响下兴起的一种新的研究取向。叙事心理治疗在社会工作运用,需要社会工作者能够建立良好的关系,耐心倾听故事叙说,在咨询中将问题外化,形成积极有力的自己观念。     

Mindfulness,meditation, and breathing exercises: reduced anxiety for clients and self-care for social work interns

ABSTRACT

The purpose of this article is to identify and describe a teaching tool that supports social work student success in the classroom and in field placement. The project introduced mindfulness, meditation, and breathing techniques to 2nd-year master of social work (MSW) students in a group classroom setting and engaged students as they applied those techniques in their internship settings with clients. Students were introduced to mindfulness, meditation, and breathing techniques through lecture, experimental exercises, video clips, and case studies and used the group setting to learn to use those tools to add trauma-informed mindfulness interventions to the clinical techniques they concurrently practiced in field placement. Students learned methods to incorporate those interventions into their psychotherapy/counseling sessions with clients and discovered that mindfulness-specific interventions also helped regulate their own autonomic nervous systems, contributing to decreased anxiety. Thus, mindfulness skills taught in social work programs have significant multidimensional benefits; engaging a group classroom setting to learn to utilize mindfulness, meditation and breathing techniques can reduce stress and anxiety for clients and promote adaptive self-care skills for MSW students.     

Converging perspectives of dynamic theory and evolving neurobiological knowledge

Exciting findings in recent research in neurobiology do not regularly appear in the social and psychological sciences literature. Yet, there is neurobiological evidence that variously supports, qualifies, and elaborates on the understanding of dynamic treatment. Early in his career, Freud lamented that the science necessary to support and advance his theorizing in the psychological realm would only become available to future generations. A case in point is that recent findings reveal that neurobiological transformations in the brain can result from specific and focused relationship interactions. Addressed here are some biological phenomena which seem to lend support for the following analytic hypotheses: structural theory (id, ego, super‐ego), defense mechanisms, object relations, free association, transference, countertransference, the therapeutic alliance, and working through.     

Reflection: Linking Service and Learning—Linking Students and Communities

While research on service–learning has been mixed, there is evidence to suggest that service–learning programs which thoroughly integrate service and academic learning through continuous reflection promote development of the knowledge, skills, and cognitive capacities necessary for students to deal effectively with the complex social issues that challenge citizens. While there is not much research in the service–learning literature that specifically addresses techniques of reflection, evidence from studies of problem–based learning, situated cognition, and cognitive development suggests approaches to reflection that will enhance the power of service–learning in attaining these important goals which facilitate full community participation. This review presents concrete suggestions about this type of program.     

Constructing social work identity based on the reflexive self

Summary In this article, the social work identity is conceptualizedbased on concepts of the self (Benjamin, 1995; Foucault, 1988),rather than concepts associated with ego psychology. Socialwork students, teachers and practitioners have historicallyattempted to gain a sense of ego mastery and control by theacquisition of theory to enhance skill-based practice expertise(Austin, 1952; Zetzel, 1953; Bandler, 1960; Memmot and Brennan,1998). In so doing, they have attempted to manage anxiety asa means to enhance learning. Traditional social work functionssuch as acceptance, non-judgemental attitudes, and empathy (Biestek,1957; Woods and Hollis, 1990) have been utilized to encouragepractitioners to manage their feelings related to difference.We argue, however, that the social work identity is enrichedwhen social workers allow their selves to be in a state of disassemblyin the presence of the other (Smith, 1997). When social workersexperience their selves as complex and dialogical, they aremore open to the influence of the other (Bakhtin, 1993). Wemake the case for practitioners to work on a reflexive selfrather than attempting to achieve ego control through the managementof anxiety.     

Palliative sedation: an essential place for clinical excellence

The complexities that converge around palliative sedation invite clinicians to work together to differentiate the issues and come to recommendations and decisions that are humane, ethical, legal, and clinically sound. Whether a crisis or long-term situation exists, the work is essentially the same. It must include critical thinking, clinical expertise, multidimensional assessment, and an array of interventions to assist patients and families in situations where symptoms and suffering are sufficiently intense to warrant exploration of sedation. The many issues inherent in the discussion of sedation at end of life require not that we have the answers but rather that we work with our colleagues to raise relevant questions and integrate both expertise and compassion into end-of-life decisions and care.     

Examining Protective Factors for Dysthymia Among Individuals Attending Substance Abuse Treatment

ABSTRACT

Dysthymia affects millions of people and has been associated with impaired psychosocial and occupational functioning and poor clinical treatment outcomes. Yet few studies have examined protective factors that can be utilized to help individuals with dysthymia in clinical settings, particularly among individuals with comorbid substance use disorders. The purpose of this study was to examine the potential protective quality of adult attachment dimensions, spirituality, and meaning in life among clients with and without dysthymia in treatment for addiction. Data were obtained from 305 self-report questionnaires administered to clients attending a residential substance abuse treatment center. Approximately 25% of the sample met criteria for dysthymia. Results from logistic regression analyses indicated that purpose and meaning in life and attachment anxiety were the most important protective factors against having dysthymia. These results suggest that mental health professionals may need to integrate these protective factors into the treatment of individuals with dysthymia and substance use disorders, which may enhance treatment outcomes and maximize treatment effectiveness. Future studies should continue to explore protective factors that can assist individuals who experience these comorbid conditions and consider replicating this study using an ethnically diverse sample and other clinical settings to determine the generalizability of the findings.     

Bipolar Illness,God, and Object Relations: The Treatment of M

This article explores the concomitant change in one client's object relations and his image of God that occurred in the context of psychoanalytically oriented psychotherapy. The case demonstrates the benefit of long-term psychoanalytically oriented treatment to help an individual with major mental illness to heal emotionally, mentally, and spiritually. The client, who suffers from bipolar I disorder, experienced significant developmental mastery as he moved from the paranoid/schizoid position to the depressive position (developmental stages conceptualized by theorists Melanie Klein and Douglas Fairbairn). In addition, the psychotherapy mitigated the effects of homonegativity on M's self-image and his experience of his homosexuality. Through our work, the client began to see and interact with this clinical social worker, others, and the God of his understanding, in a more realistic and healthy manner. M's participation in a 12-Step group and his adherence to its beliefs augmented changes he made through psychotherapy. Through a long-term psychoanalytically oriented psychotherapy and involvement in Al-Anon meetings, the client's belief in a punishing God shifted toward a more benevolent one—a God who had a plan for his life that was revealed through the transformation of his suffering. In summary, M's object relations changed toward a greater balance of emotions and development of more textured relationships, including his relationship toward himself and God.