Clinical Social Work and Use of
Practice Theories plus Models
SOW6425 Clinical Assessment and
Intervention Planning
Professor Nan Van Den Bergh, PhD,
LCSW
Definition of Practice Theory
• A coherent set of ideas about human nature, including concepts of :
– Health and illness
– Normalcy and deviance
– The nature of change
• Practice theory provides:
– verifiable or established explanations for behavior
– rationales for intervention.
Types of Theories
• Case theories: explain behavior of one client
– What is your “theory” about the causes of a client's behavior?
• Mid-range theories: explain a set of behaviors
– Explanation as to why unemployed males can demonstrate
domestic violence
• Grand theories: explain human development, as well as
“causes” and “cures” for maladaptive states, which can
be generalized across populations
– Freud’s theory of psychosexual development
– Erickson’s “developmental crises” theory of human
development
– Piaget’s theory of cognitive development
Practice Theory Functions
• Simplifying complex phenomena into a focus on client’s thoughts, feelings
and behaviors
• Identifying our knowledge gaps about clinical situations
• Explaining and predicting client cognitions and behavior
• Bringing order to the selection of intervention targets and strategies
• Bolstering professional self-discipline by protecting against irrational
procedures
• Promoting generalization among clients by cumulative practice knowledge
• Mobilizing social energy to coordinate the work of other service providers
• Enhancing our status within our agencies and among our peers
Benefits of Theory
Theory Focuses Attention
•
When the social worker “knows” what to do, assessment and intervention
activities make better use of time and other therapeutic resources
•
Commitment to a body of thought “greater than oneself” bolsters
professional self-discipline.
•
In “naive eclecticism” our choices for intervention might emerge outside of
awareness and be influenced by irrational factors
Theory Protects the Client
•
The worker can maintain a healthy distance from the client.
•
Without a theoretical base, “clinical skepticism may be subverted in the
service of empathy”.
Challenges of Using Theory
• There is a potential harm of rigidly adhering to any
practice theory.
• Since theories simplify complex human behavior, they:
• Are reductionist
• Can be anti-humanistic
• Create self-fulfilling prophecies by biasing
perceptions of the client
• Blind us to alternative understandings of behavior.
THE RELATIONSHIP OF THEORY TO PRACTICE
“Primary” Practice Theory (for Assessment)
(Fits the practitioner’s assumptions about human nature)
Practice Model
(( A guiding strategies for working with certain types of clients)
Practice Strategies
(A guiding strategy for approaching a specific client)
Interventions
(The implementation of practice strategies; what we actually do
to facilitate the change process)
Relationship Between Theory and Intervention
Strategies
• Not every theory has unique intervention strategies
– i.e. relaxation exercises or mindfulness practices could be
use by both a behaviorist as well as an ego psychologist
– Ego psychologist may see psychodynamics at root of
addiction; but, use behavioral methods for changing selfdestructive behavior
Theory and Practitioner’s “Practice Model”
• Practice model: guiding strategy for working with certain
types of clients
– i.e. Begin with behavioral techniques to extinguish destructive
and encourage constructive behavior
– Then, undertake reflective interventions for insight
development (person-situation reflection)
• Practice Strategy is the individualization of a
practice model” to a specific client’s personal and
environmental characteristics
– One client may be receptive to mindfulness practices
whereas another is not
Curative Factors in All Practice Interventions
• Perception of practitioner, by client, as competent and caring
– Therapeutic alliance
• “Special setting” of seeking therapy promotes client’s sense of safety and
expectation of help
• Interventions and procedures are based on an rationale which is
understandable(to the client), and theyn include an optimistic view of
human nature.
• Practitioner is “congruent” with client’s perception of problem and world
view
– Practitioner’s ongoing attention too client’s frame of reference
• Client is given new opportunities for enhancing mastery
Curative Factors in Practice (cont.)
• Miller, Duncan and Hubble (2005):
– Client characteristics associated with clinical
outcome (account for 40% of outcome):
• Nature of the problem
• Motivation
• Participation
– Quality of therapeutic alliance (30%)
– Guiding theory or model (15%)
– Placebo effect (15%)
Curative Factors in Practice (cont.)
• Carkoff and Truax: Predictors to client
retention in treatment:
– Empathy
– Congruence
– Genuineness
Practitioner’s Reasons for Theory Selection
(both rational and irrational factors)
• The theory’s research support
• Belief that theory produces positive results (with the
least expenditure of time and money)
• It’s provision of useful intervention techniques
• It’s consistent with practitioner's values, knowledge,
skills and worldview
• Personal habit
• It’s use by co-workers or supervisor/s
Selecting a Theory for Practice
• A good theory for practice should be:
– Coherent (internally consistent)
– Useful with the practitioner's current clients
– Comprehensive (applicable across a range of
clients)
– Parsimonious (uncomplicated to use)
– Testable and able to withstand scrutiny (there are
a variety of methods for doing this
CLINICAL PRACTICE THEORIES
• Focus on Reflection/Insight: Psychodynamic Theories
• Ego Psychology (for individuals and groups)
• Object Relations (for individuals and groups)
• Self Psychology (for individuals and groups)
• Family Emotional Systems: Bowen (can be applied
to individuals and couples as well as families)
CLINICAL PRACTICE THEORIES (cont.)
• Focus on Conscious Thought / Observable Behavior
• Cognitive Theory (for individuals and groups)
• Behavioral Theory ((for individuals and groups)
• Structural Family Theory: Minuchin
CLINICAL PRACTICE THEORIES (cont.)
• Focus on Relationship:
– Relational Theory and Cultural Relational Theory
– Interpersonal Therapy (a model)
– Feminist Therapy (a model)
– Afrocentric Therapy (a model)
CLINICAL PRACTICE THEORIES (cont.)
• Models and “Newer” Theories:
–
–
–
–
Crisis Theory and Intervention
Solution–focused therapy
Narrative Theory and Therapy
Motivational Interviewing