THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL SCHOOL OF SOCIAL WORK COURSE NUMBER: SOWO 857 COURSE TITLE: ADVANCED CLINICAL PRACTICE WITH FAMILIES SEMESTER AND YEAR: FALL 2012 INSTRUCTOR: Paul R Smokowski, M.S.W., Ph.D., C.P. School of Social Work CB # 3550, 325 Pittsboro St. Chapel Hill, NC 27599-­‐3550 Phone: 919-­‐843-­‐8281, also 919-­‐960-­‐3607 Email: smokowsk@email.unc.edu OFFICE HOURS: Immediately after class or by appointment. Email me for a meeting appointment or to ask a question. I am easily accessible by email. COURSE DESCRIPTION: This advanced practice course is devoted to intervention with families. Intervention methods will be applied to families coping with major life stressors and relational problems. Family therapy models are covered. COURSE OBJECTIVES: By the end of the course, students will: 1. Understand issues social workers (therapists) face in working with families, especially those issues that differentially affect clinical work with families from socioeconomically disadvantaged, vulnerable, and oppressed groups, with emphasis on women, on individuals with disabilities, on gays and lesbians, on African-­‐Americans, on Latinos, and on other minority groups. 2. Articulate how stressors and problems (such as depression, anxiety, or substance use) both influence family patterns of functioning and are potentiated by family patterns of functioning. 3. Describe the role of explanatory and practice theory in social work, and compare and contrast the concepts and assumptions that underpin major conceptual frameworks for social intervention with families. Major conceptual frameworks for social intervention with families that will be focused on are: systemic, structural, communications, experiential, psychodramatic, psychodynamic, and cognitive-­‐behavioral family intervention. 4. Formulate a comprehensive assessment of a family using appropriate concepts and measures from our research and clinical knowledge base on family functioning. 5. Apply conceptual frameworks and models of family intervention to case examples and demonstrate mastery of the practice models in simulated sessions (e.g. role play scenarios) with clients. 6. Understand and articulate how social work values and ethics guide social interventions with families. EXPANDED DESCRIPTION: This course is facilitated as a skills-­‐training laboratory for working with families. Relational patterns and processes, rather than individual concerns, will be stressed. Development of family systems thinking and acquisition of advanced assessment and social intervention skills will be paramount throughout the semester. Using a diverse array of interactive exercises, video modeling, and simulation scenarios will facilitate skills acquisition. Students will be expected to maintain a high level of active participation, will demonstrate their practice skills in front of others, and will serve as consultants for each other. Special emphases will be placed on vulnerable, disadvantaged, and diverse families. This is an advanced practice elective in the Direct Practice Concentration. It will be expected that students have already had an advanced HBSE course in their Field of Practice. Field experience working with families is particularly helpful for working in this class. Students should leave this course with increased confidence in their ability to analyze patterns, assess, and intervene using diverse family systems perspectives. REQUIRED TEXTS/READINGS: Nichols, M. & Schwartz, R.C. (2010). Family therapy: Concepts and methods (9th Edition). Needham Heights, MA: Allyn and Bacon. [I will focus on the latest edition of this book. However, students can buy an earlier edition, an e-­‐edition, or a used copy if they wish. If students buy alternative copies, it is the student’s responsibility to check the reading topics and reconcile different page numbers than are assigned in the syllabus.] The text is available at the student bookstore or can be ordered over the internet (e.g., www.amazon.com, www.bestbookbuys.com, or www.textbooks.com) Readings from sources other than the textbooks are available on Sakai.unc.edu. Web sites: www.serendip.brynmawr.edu/complexity/Chalquist2.html -­‐ Paradigm Shift www.aamft.org -­‐ American Association of Marriage and Family Therapy www.afta.org -­‐ American Family Therapy Academy www.abacon.com/famtherapy/profiles.html -­‐ Family Therapy Profiles & History www.anzjft.com/links.htm -­‐ Family Therapy Resources on the Web www.ericdigests.org/pre-­‐9211/counseling.htm -­‐ Counseling families from a systems perspective TEACHING METHODS The development of a supportive learning environment, reflecting the values of ethical clinical practice, is essential for the success of this class. A supportive learning environment is fostered by listening to the ideas and views of others, being able to understand and appreciate a point of view that is different from your own, articulating clearly your point of view, and linking experience to readings and assignments. I appreciate your contributions to making this a safe and respectful class for learning and growth. I will use interactive experiential exercises for learning family therapy clinical skills. We will simulate sessions with clients and students, using role playing in each class session. In order to maximize learning in this class, students must come ready to participate. I value spontaneity and willingness to try new behaviors. CLASS ASSIGNMENTS Mid-­‐Term Paper: Assessment of a Family -­‐ Assess a family that you are familiar with. This can be a family you worked with in your internships, a friend’s family, or a family presented in a video of your choice (with prior approval by the instructor). For this assignment, families must have at least three members. It is harder to assess your family of origin or your family of choice for this assignment. If you choose your own family, students MUST assess your own roles and contributions to family dynamics. This requires a higher level of self-­‐awareness for this assignment, compared to analyzing a family you are not a part of. Show that you understand the basic concepts necessary to do a family assessment. Apply concepts from the course texts and class discussions to the family you assess. You must show competence in analyzing family process dynamics. Consider concepts such as family system roles, boundaries, projections, emotional cutoffs, rules, traditions, strengths, risk factors and major transitions. Use approximately 4 pages to assess the family’s dynamics. Then, you must discuss how you would plan to intervene with this family. If there is a particular model you would use, please indicate this and say why you would choose this model. Length of paper: 6 pages, double-­‐spaced, typed. This paper is due during our fourth class day -­‐ September 16, 2012. Students will email your paper to me. The file name must include your last name, the class number, and the assignment (e.g., “smith-­‐857midterm paper.doc”. This paper is worth 35% of your class grade. Theoretical Matrix -­‐ Students will fill in a comprehensive matrix detailing the aspects of different schools of family therapy. I will hand out the blank matrix. This is worth 15% of the final grade. It will be completed and submitted by email by the 5th class meeting, October 13, 2012. Demonstration of Practice Skills -­‐ Students must be able to put skills that are presented in class into practice. Analyzing in writing is not enough. Consequently, students will be graded on the quality of their clinical skills. Clinical skills will be evaluated using role play simulations throughout the semester. If a student does not believe that his or her skills are adequately demonstrated in a clinical simulation, he or she can negotiate with the professor to demonstrate these clinical skills using another medium (i.e. submitting a videotape). This will be a rare case. Participation in role-­‐playing is expected. I will give the most weight to skills demonstrated at the end of the semester when students should have the most expertise and feel most comfortable role-­‐playing. However, I will also take into account how much growth students have shown in their skills from the beginning to the end of the semester. Demonstration of practice skills and class participation is worth 15% of the class grade. Presentations of Paper Plans – On the final day of class, each student will have 5 minutes to present information about their final paper research topic. You must have some beginning material to share with your classmates. The presentation is worth 5% of the final grade. [Note: Because of the concentrated weekend format for the class, these presentations may stress that the paper is a work in progress. It does not have to be completed work. However, it must delineate the student’s thinking and current state of research on his or her topic of choice.] Final Paper -­‐ Each student will choose one topic that relates to family stress and dysfunction (e.g. substance abuse, marital infidelity, adolescent delinquency) and will describe in detail how at least two systems of family therapy would intervene in a family experiencing that stressor. The paper must include a detailed discussion of clinical techniques that are used by clinicians working with families with the chosen stressor. This will serve as the final exam for the course. This paper is due by 5pm on November 2, 2012. Students will submit by email. This final paper will be 10 double spaced pages long, in APA format with references appropriately cited from professional sources (e.g. scholarly journals and books). At least five references to professional literature are required to be included in the paper. The final paper is worth 30% of your class grade. ATTENDANCE AND PARTICIPATION Attendance is required and the class will rely heavily on discussion and participation in role-­‐playing. It is expected that students will read the material and apply and discuss readings and field experiences in class. Students are expected to attend all class sessions. If there is some reason that you cannot attend a class, please contact me. Students who miss two or more full class sessions will be penalized by one letter grade. The Instructor will also track tardiness. Coming in more than fifteen minutes late is tabulated as missing half a class session. In the concentrated weekend format, missing class is a serious problem. If two or more days of class are missed, the student should drop the class. Class Participation: Students are expected to contribute "meaningfully" to class discussion. The instructor may call upon students to respond to assigned readings/class discussion. Please let me know if you have special concerns about speaking in front of the class. At the beginning of each class session, time will be allocated to address questions about readings/assignments. GRADING SYSTEM The School of Social Work operates on an evaluation system of Honors (H), Pass (P), Low Pass (L), and Fail (F). For this class, the numerical value of an H ranges from 94 -­‐ 100; a P is 80 -­‐ 93; an L is 70 -­‐ 79. A grade of P is considered entirely satisfactory. On a traditional grading scale, a P would range from B-­‐ to A-­‐. The grade of Honors signifies that the work is clearly excellent in all respects. Only a small percentage of students attain Honors. A student receiving nine or more Low Passing credits is ineligible to continue in graduate school. The final grade for the course will be determined as follows: Family Assessment Midterm 35% Due September, 16th Theoretical Matrix 15% Due October 13th Demonstration of Practice Skills 15% Ongoing & Class Participation Presentation of Final Paper Material 5% October 14th Final Lit Review Paper 30% November 2nd POLICY ON INCOMPLETES AND LATE ASSIGNMENTS Unless negotiated in advance with the professor, assignments are due on the date specified in the syllabus. Submitting assignments late must be negotiated with me. Five points will be deducted from assignments turned in late (within 48 hours). Students will receive no points on assignments not submitted within the 48 hours from the due date. POLICY ON ACADEMIC DISHONESTY: All academic work submitted by students will be conducted within the guidelines and spirit of the Honor Code, which is described in The SSW Manual and the Graduate School Record. Please refer to the APA Style Guide, The SSW Manual, and the SSW Writing Guide for information on attribution of quotes, plagiarism and appropriate use of assistance in preparing assignments. All written assignments should contain a signed pledge from you stating that, “I have not given or received unauthorized aid in preparing this written work.” In keeping with the UNC Honor Code, if reason exists to believe that academic dishonesty has occurred, a referral will be made to the Office of the Student Attorney General for investigation and further action as required. POLICY ON ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES: Students with disabilities that affect their participation in the course may notify me if they wish to have special accommodations in instructional format, examination format, etc., considered. READINGS AND COURSE OUTLINE DAY 1 (AUGUST 25) MORNING (8/25): Moving from Individual to Family Practice Introduction, Overview of Syllabus Assumptions underlying practice with families Practice Skills Emphasized: How to move from individual, to couples, and finally to family interventions. Nutt R.L. & Stanton, M. (2008). Family psychology specialty practice. Professional Psychology: Research and Practice, 39(5), 519-­‐528. AFTERNOON (8/25): Family Assessment -­‐ Family Processes, Systems, and Stress Topic: What makes a family functional or dysfunctional? The fundamental concepts of family therapy. Practice Skills Emphasized: Circular Questioning Required reading for this class Nichols, M. & Schwartz, R.C. (2010). Family therapy: Concepts and methods (6th Edition). Needham Heights, MA: Allyn and Bacon. Read Chapters 1 through 4 with special attention given to Chapter 4-­‐The Fundamental Concepts of Family Therapy. Recommended Reading Hughes, Elizabeth K.; Gullone, Eleonora (2008). Internalizing symptoms and disorders in families of adolescents: A review of family systems literature. Clinical Psychology Review, 28(1), 92-­‐117. Hooper, Lisa M.; (2007). The application of attachment theory and family systems theory to the phenomena of parentification. The Family Journal, 15(3), 217-­‐223. DAY 2 (August 26) Unit I: Foundations: Action-­‐oriented Brief Family Therapy MORNING (8/26): Action Methods for Family Intervention Topic: How to use brief, action-­‐oriented techniques in marital and family therapy. Action Techniques: Role reversal, mirroring, doubling, soliloquy Required reading for this class Blatner, A. (1999). Psychodramatic methods in psychotherapy. In D.J. Wiener (Ed.) (1999). Beyond Talk Therapy: Using Movement and Expressive Techniques in Clinical Practice. Washington, D.C.: APA, pp.125-­‐143. Proctor, K., Perlesz, A., Moloney, B., O'Neill, I. & McIlwaine, F.; (2008). Exploring theatre of the oppressed in family therapy clinical work and supervision. Counseling & Psychotherapy Research, Vol 8(1), Mar, 2008. Special issue: Australian Counseling and Psychotherapy Research. 43-­‐52. Leveton, E. (2005). Escaping the Blame Frame: Experiential Techniques With Couples. Journal of Group Psychotherapy, Psychodrama & Sociometry, 58(2), .Special issue: Treatment of Couples and Families With Psychodrama and Action Methods: The Case of Generic Psychodrama. pp. 55-­‐69. Wiener, D.J. (1999). Rehearsals for growth: Applying improvisational theater games to relationship therapy. In D.J. Wiener (Ed.) (1999). Beyond Talk Therapy: Using Movement and Expressive Techniques in Clinical Practice. Washington, D.C.: APA, pp.165-­‐180. Wiener, D.J. & Pels-­‐Roulier, L. (2005). Action Methods in Marriage and Family Therapy: A Review. Journal of Group Psychotherapy, Psychodrama & Sociometry, 58(2). Special issue: Treatment of Couples and Families With Psychodrama and Action Methods: The Case of Generic Psychodrama. pp. 86-­‐101. AFTERNOON (8/26): Techniques used in Early Sessions Action Techniques: Putting ecomaps into action, spectograms, the Diamond of Opposites Required reading for this class Nichols, M. & Schwartz, R.C. (2010). Family therapy: Concepts and methods (6th Edition). Needham Heights, MA: Allyn and Bacon. Read Chapters 1 through 4 with special attention given to Chapter 4-­‐The Fundamental Concepts of Family Therapy. Kipper, D.A. & Ritchie, T.D. (2003). The effectiveness of psychodramatic techniques: A meta-­‐analysis. Group Dynamics: Theory, Research, and Practice, 7(1),13-­‐25. Fow, N. R. (1998). Partner-­‐focused reversal in couple therapy; Psychotherapy: Theory, Research, Practice, Training, 35(2), 231-­‐237. Day 3 (September 15) Unit II: Classic Family Therapy Intervention Models MORNING (9/15): Bowenian Systems Approaches Required reading for this class Nichols, M. & Schwartz, R.C. (2010). Family therapy: Concepts and methods (5th Edition). Needham Heights, MA: Allyn and Bacon. Read Chapter 5 (Bowen Family Systems Therapy). Farmer, C. & Geller, M. (2005). The Integration of Psychodrama With Bowen's Theories in Couples Therapy. Journal of Group Psychotherapy, Psychodrama & Sociometry, Vol 58(2). Special issue: Treatment of Couples and Families With Psychodrama and Action Methods: The Case of Generic Psychodrama. pp. 70-­‐85. Butler, John F. (2008). The family diagram and genogram: Comparisons and contrasts. American Journal of Family Therapy, 36(3), 169-­‐180. Recommended Readings Bartle-­‐Haring, Suzanne; Glebova, Tatiana; Meyer, Kevin; (2007). Premature Termination in Marriage and Family Therapy within a Bowenian Perspective. American Journal of Family Therapy, 35(1), 53-­‐68. Cook, L. (2007). Perceived conflict, sibling position, cut-­‐off, and multigenerational transmission in the family of origin of chemically dependent persons: An application of Bowen Family Systems Theory. Journal of Addictions Nursing, 18(3), 131-­‐140. Web Sites: www.genopro.com/ -­‐ genogram information and charts www.genogram.freeservers.com/ -­‐ information about genograms www.faculty-­‐web.at.nwu.edu/commstud/galvin/genograms/ -­‐ Understanding, creating and interpreting genograms Video Aids: Bowenian Therapy with Philip Guerin or Family Secrets Practice Skills Emphasized: Working with Triangles and intergenerational projections; Working with the family projection process in action. AFTERNOON (9/15): Structural Approaches Required reading for this class Nichols, M. & Schwartz, R.C. (2010). Family therapy: Concepts and methods (6th Edition). Needham Heights, MA: Allyn and Bacon. Read Chapter 7 (Structural Family Therapy). Kim, J.M. (2003). Structural Family Therapy and Its Implications for the Asian American Family. The Family Journal, Vol 11(4), 388-­‐392. Springer, D. W. & Orsbon, S.H. (2002). Families helping families: Implementing a multifamily therapy group with substance-­‐abusing adolescents. Health & Social Work, 27(3), 204-­‐207. Vetere, A. (2001). Structural family therapy. Child Psychology & Psychiatry Review, 6(3), 133-­‐139. Web sites: www.abacon.com/famtherapy/minuchin.html -­‐ Salvador Minuchin www.psycservice.vt.edu/resources/manuals/Structural_Family_Therapy_Manual.pdf www.philafamily.com/ Philadelphia Child and Family Therapy Training Center Video Aids: Aponte working with a Latino blended family Practice Skills Emphasized: Boundary-­‐Making DAY 4 (September 16) MORNING (9/16): Solution-­‐Focused Approaches Required reading for this class Nichols, M. & Schwartz, R.C. (2010). Family therapy: Concepts and methods (5th Edition). Needham Heights, MA: Allyn and Bacon. Read Chapter 12 (Solution-­‐ Focused Family Therapy). O’Halloran, M.S. (1999). Family Involvement in the Treatment of Anorexia Nervosa: A Solution-­‐Focused Approach. The Family Journal 7; 384-­‐388. Corcoran, J. (2002). Developmental adaptations of solution-­‐focused family therapy. Brief Treatment and Crisis Intervention, Vol 2(4), 301-­‐313. Aambo, Arild (1997). Tasteful solutions: Solution-­‐focused work with groups of immigrants. Contemporary Family Therapy: An International Journal, Vol 19(1), 63-­‐79. Practice Skills Emphasized: Working with the Miracle Question in action AFTERNOON (9/16): Strategic & Cognitive Behavioral Approaches Required reading for this class Nichols, M. & Schwartz, R.C. (2010). Family therapy: Concepts and methods (5th Edition). Needham Heights, MA: Allyn and Bacon. Read Chapter 6 (Strategic Family Therapy) and Chapter 10 (Cognitive Behavioral Family Therapy). Avrahami, E. (2003). Cognitive-­‐behavioral approach in psychodrama: Discussion and example from addiction treatment. The Arts in Psychotherapy, Vol 30(4), 2003. pp. 209-­‐216. Treadwell, T. W. Kumar, V. K. & Wright, J. H. (2002). Enriching psychodrama through the use of cognitive behavioral therapy techniques. Journal of Group Psychotherapy, Psychodrama & Sociometry, 55(2-­‐3), 55-­‐65. Recommended Reading Cannon, E. & Levy, M. (2008). Substance-­‐using Hispanic youth and their families: Review of engagement and treatment strategies.; The Family Journal, 16(3), 199-­‐203. Distelberg, B. J. (2008). History of evidence-­‐based practices: An interview with José Szapocznik. The Family Journal, 16(2), 173-­‐179. Gardner, B.C., Burr, B.K., & Wiedower, S.E. (2006). Reconceptualizing Strategic Family Therapy: Insights from a Dynamic Systems Perspective. Contemporary Family Therapy: An International Journal, 28(3), 339-­‐352. Santisteban, D.A., Suarez-­‐Morales, L. Robbins, M.S., Szapocznik, J. (2006). Brief Strategic Family Therapy: Lessons Learned in Efficacy Research and Challenges to Blending Research and Practice. Family Process, 45(2), 259-­‐271. Video Aids: Strategic Therapy with James Coyne Practice Skills Emphasized: Working with anxiety and depression in action Mid-­‐Term Paper: Assessment of a Family due by September 16, 2012, 5pm. Day 5 (October 13) MORNING (10/13): Communications Approaches Required reading for this class McLendon, J. (1999). The Satir system in action. In D.J. Wiener (Ed.) (1999). Beyond Talk Therapy: Using Movement and Expressive Techniques in Clinical Practice. Washington, D.C.: APA, pp.29-­‐54. Beaudry, Gilles; (2002). The family reconstruction process and its evolution to date: Virginia Satir's transformational process. Contemporary Family Therapy: An International Journal, Vol 24(1), 79-­‐91. Roberts, J. (1999). Beyond words: The power of rituals. In D.J. Wiener (Ed.) (1999). Beyond Talk Therapy: Using Movement and Expressive Techniques in Clinical Practice. Washington, D.C.: APA, pp.55-­‐78. Lee, Richard H.; (2005). The couple's therapist as coaching double in a model encounter. Journal of Group Psychotherapy, Psychodrama & Sociometry, Vol 58(3), 107-­‐118. Video Aids: Jean McLendon working with an African American single mother and her son. Or Virginia Satir video. Practice Skills Emphasized: Family sculpting and communication typologies AFTERNOON (10/13): Psychodynamic & Experiential Approaches Required reading for this class Nichols, M. & Schwartz, R.C. (2010). Family therapy: Concepts and methods (5th Edition). Needham Heights, MA: Allyn and Bacon. Read Chapters 8 (Experiential Family Therapy) and 9 (Psychoanalytic Family Therapy). Kanofsky, S. & Lieb, R. J. (2007). Control Mastery Theory and family therapy. Psychotherapy: Theory, Research, Practice, Training, 44(3), 316-­‐332. Klontz, B.T., Wolf, E.M. & Bivens, A. (2000). The effectiveness of a multimodal brief group experiential psychotherapy approach. International Journal of Action Methods: Psychodrama, Skill Training, and Role Playing, 53(3-­‐4), 119-­‐135. Webb sites: www.internalfamilysystems.org/ -­‐ Internal Family Systems www.earley.org/internal_family_systems_therapy.htm www.soulselfhelp.on.ca/internal.html -­‐ Internal Family Systems www. wisdomresources.dolphin-­‐designs.com/IFS.html -­‐ definitions www.earley.org/intro_ifs.htm -­‐ Intro to IFS Video Aids: John Edwards video Practice Skills Emphasized: Using metaphor, imagery, and role-­‐playing Day 6 (October 14) MORNING (10/14): Theoretical Matrix – Comparing and Contrasting Models Required reading for this class Nichols, M. & Schwartz, R.C. (2010). Family therapy: Concepts and methods (5th Edition). Needham Heights, MA: Allyn and Bacon. Read Chapters 15 (Comparative Analysis), and 16 (Research on Family Intervention). Pay special attention to the comparative analyses in Chapter 15. Vetere, A. & Dallos, R. (2008). Systemic therapy and attachment narratives. Journal of Family Therapy, 30(4), 374-­‐385. Besa, David (1994). Evaluating narrative family therapy using single-­‐system research designs. Research on Social Work Practice, Vol 4(3), 309-­‐325. Narrative Therapy & Integrating Models Required reading for this class Nichols, M. & Schwartz, R.C. (2010). Family therapy: Concepts and methods (5th Edition). Needham Heights, MA: Allyn and Bacon. Read Chapters 13 (Narrative Therapy) and 14 (Integrating Models). Green, E.J. (2008). Individuals in conflict: An Internal Family Systems approach. The Family Journal, 16(2), 125-­‐131. Price, David M. (2004). Rebuilding Shattered Families: Disclosure, Clarification and Reunification of Sexual Abusers, Victims, and Their Families. Sexual Addiction & Compulsivity, 11(4), 187-­‐221. Practice Skills Emphasized: Changing family narratives; Internal Family Systems Therapy AFTERNOON (10/14): Student presentations of final paper material. Difficult practice situations Required reading for this class Nichols, M. & Schwartz, R.C. (2010). Family therapy: Concepts and methods (5th Edition). Needham Heights, MA: Allyn and Bacon. Read Chapters 13 (Narrative Therapy) and 14 (Integrating Models). Wrap Up, Final Paper due by November 2, 2012, 5pm