853 Tuesday – Grady 1 THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL School of Social Work Spring Semester, 2009 COURSE NUMBER: COURSE TITLE: TIMES: SOWO 853 Brief Treatment Mondays 9:00-11:50 am, Spring Semester INSTRUCTOR: Melissa D. Grady, Ph.D., L.C.S.W. TTK 563-H; 919-843-0063 mgrady@email.unc.edu Mondays 12-2 pm and Tuesdays 12-3 is available through http://blackboard.unc.edu OFFICE HOURS: COURSE WEBSITE: COURSE DESCRIPTION: This advanced practice elective covers theories and application of three models of brief psychotherapy. Skill building, critical thinking, and utilization of empirical support are emphasized. COURSE OBJECTIVES: 1. Knowledge of and beginning practice skills in models of brief treatment including psychodynamic brief psychotherapy, cognitive-behavioral brief psychotherapy, and solution focused brief therapy. In addition, the students will learn some of the prominent models of trauma intervention. 2. An understanding of managed care and its impact on mental health practice. 3. The ability to apply evidence and client factors when considering choices around intervention models. 4. Knowledge of ethical considerations in brief treatment. 5. An ability to assess, formulate goals and design intervention strategies for clients using the models of practice introduced in the course. 6. Critically examine how client factors such as race, sexual orientation, gender identity, spiritual beliefs, ethnicity, class, and other characteristics impact the implementation of social work interventions. EXPANDED DESCRIPTION: This is an advanced direct practice elective. It is conducted as a seminar with the classes involving a combination of lecture, discussion, skill-building exercises, and videotaped case examples. The models covered will include solution-focused, cognitive-behavioral, trauma and psychodynamic/interpersonal models applied to planned short-term treatment as well as crisis intervention. Topics such as cultural competence, managed care, and common crises will be 1 853 Tuesday – Grady 2 discussed. Students will be challenged to consider how ethical issues, managed care, client differences (e.g. race, ethnicity, gender identity, sexual orientation, class, spiritual beliefs) and the evidence based practice process all impact both the choices of intervention, as well as how each intervention will need to be uniquely tailored to individual clients’ needs. With each model presented, students will consider the role of the relationship and the difference in the use of self o the worker. REQUIRED TEXTS: Beck, Judith S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press. de Shazer, S., & Dolan, Y. (2007). More than miracles: The state of the art of solution-focused brief therapy. Binghamton, NY: The Haworth Press, Inc. OTHER READINGS: All other readings will be on the Blackboard website for the course. TEACHING METHODS: The development of a supportive learning environment, reflecting the values of the social work profession, 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 which is different from your own, articulating clearly your point of view, and linking experience to readings and assignments. I will appreciate your contributions to making this a safe and respectful class for learning and growth. CLASS ASSIGNMENTS: 1. The course will be conducted as a seminar, so being present and participating actively is essential to the learning experience. Attendance will be noted and utilized in determining the final grade. If it is necessary to miss, the instructor should be contacted in advance and arrangements should be made to get class notes from another student. Active participation in discussion is important, but quality of comments and questions is more important than quantity. Case illustrations are encouraged and will enhance class participation grade. Please see class participation criteria below 2. It is assumed that students are adult learners who have already become proficient at assimilating information. Therefore it is expected that discussion and learning can take place at the level of evaluating ideas as to their plausibility, place in the larger body of social work knowledge, strengths, limitations, and clinical relevance. 3. A journal will be turned in near the end of each unit. (See Appendix B for Grade sheet) 4. One paper is assigned. (See Appendix A for Grade Sheet) 2 853 Tuesday – Grady 3 EVALUATING PERFORMANCE: Weighting of class assignments is as follows: 30% Paper 10% Class Attendance and Participation 20% Each Unit’s Journal Entries (Total 60%) Please put your PID ONLY on the papers – NOT your name – on any written work or assignments that you turn into the instructor. CLASS PARTICIPATION: It is expected that students will be active members of the class. Therefore, the following grading rubric will be used for class participation. 94-100 is assigned to those students who have consistently attended and have been active participants. 90-93 is for students who have missed one class, but who regularly participate. 85-89 is for students who have either attended regularly, but do not participate often, or for students who participate, but do not have very regular attendance (miss 2 classes). 80-84 is for students who have do not participate actively, but may have fairly regular attendance (2 classes). Under 80 means that the student has irregular attendance (3 or more classes), and has demonstrated through class discussions that s/he has not done the readings or actively disengages with class activities. GRADING SYSTEM All grades are converted to the following scale: 94 and above H 80-93 P 70-79 L 69 and below F POLICY ON INCOMPLETES AND LATE ASSIGNMENTS: It is expected that assignments will be completed at times noted in the syllabus. If you have a situation arise that may prohibit you from completing the assignment on time, any request for delay of an assignment/exam must be done in advance of the due date (at least 24 hours) on an assignment/exam. Approved delays will not affect the grade. Any unapproved delays or assignments completed after an approved delay date will begin to accrue a 10% reduction every 24 hours that the assignment is late. Papers are due at the start of class. Papers that are handed in after the beginning of class will be considered late and there is a 10% deduction for every 24 3 853 Tuesday – Grady 4 period past the due date/time of the paper. In other words, if the paper is due at 2:00, and turned in at 11:00 pm that night, there will be a 10% deduction. The clock begins at the start of class. If the student meets unavoidable obstacles to meeting the time frame, the student should discuss the circumstances with the instructor to determine if an initial grade of incomplete (INC) would be appropriate. I prefer not to give an incomplete grade and will give incompletes only in compliance with University policy. POLICY ON ACADEMIC DISHONESTY 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 which affect their participation in the course may notify the instructor if they wish to have special accommodations in instructional format, examination format, etc. Please contact the University’s Disability office to request the paperwork necessary for approved accommodations. USE OF LAPTOPS OR OTHER ELECTRONIC DEVICES No laptops or other electronic devices are permitted in the classroom, unless you have a specific documented learning disability. Please turn off all cell phones or other devices that would disrupt the learning environment of the classroom. APA FORMATTING It is an expectation of this course that you will correctly cite all of your material following the 5th ed. of the APA manual. If you are not familiar with this style, please refer to the manual, the study guide on the school’s website or see Diane Wyant, the School’s editor at dwyant@email.unc.edu 4 853 Tuesday – Grady 5 Course Schedule: January 12 Class 1 - Introductions January 26 Class 2 – Psychodynamic: Intro February 2 Class 3 – Psychodynamic: Techniques February 9 Class 4 – Psychodynamic: Application February 16 Class 5 – Psychodyamic/IPT with children and adolescents February 23 Class 6 – CBT: Review/Techniques Journal on Psychodynamic Therapy Due March 2 Class 7 – CBT: Application/Narrative differences March 16 Class 8 – CBT: Application with children and adolescents March 23 Class 9 – SFT: Introduction Journal on CBT Due March 30 Class 10 – SFT: Techniques and application April 6 Class 11 – SFT: Application with children and adolescents April 13 Class 12 – Comparison of all three models Journal on SFT Due April 20 Class 13 – Crisis Intervention April 27 Class 14 – Course wrap-up Final Paper Due 5 853 Tuesday – Grady 6 Course Outline Class 1: Introduction Overview of the Course History and ethics of Brief Social Interventions Client Selection Goal Setting Managed Care Skill-Building Exercise in Client Selection Skill-Building Exercise in Formulating Measurable Behavioral Objectives Class 2: Intro to Psychodynamic Psychodynamic Developmental Models History of Model/Basic tenets Readings: Walsh, J. (2006). Ego psychology. In Theories for direct social work practice (pp. 28-55). Belmont, CA: Thompson Brooks/Cole. Walsh, J. (2006). Object relations. In Theories for direct social work practice (pp. 56-79). Belmont, CA: Thompson Brooks/Cole. Brandell, J. (2004). Enter Freud: Psychodynamic thinking in clinical social work. In Psychodynamic social work (pp. 3-24). New York, NY: Columbia University Press. Class 3: Psychodynamic Techniques Skill-Building Exercise in Client Selection, Formulating a Focal Issue Psychodynamic techniques: Confrontation, Clarification, Interpretation Evidence base for psychodynamic models Readings: Dulmus, C.N., & Wodarski, J.S. (2002). Six critical questions for brief therapeutic interventions. Brief Treatment and Crisis Intervention, 2(4), 279-285. Gabbard, G. (2005). Major modalities: Psychoanalytic/psychodynamic. In G. Gabbard, J.S. Beck, & J. Holmes (Eds.) Oxford textbook of psychotherapy (pp. 3-13). NY: Oxford University Press. Leichsenring, F., Rabung, S., & Leibing, E. (2004). The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders. Archives of General Psychiatry, 61, 1208-1216. 6 853 Tuesday – Grady 7 Read one of the following empirical research articles: Fonagy, P., Roth, A., & Higgitt, A. (2005). Psychodynamic psychotherapies: Evidence-based practice and clinical wisdom. Bulletin of the Menninger Clinic, 69(1), 1-58. Hoglend, P. (2003). Long-term effects of brief dynamic psychotherapy. Psychotherapy Research, 13(3), 271-292. Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis. Journal of the American Medical Association, 300(13), 1551-1565. Class 4: Psychodynamic and its application Additional techniques, such as resistance Application of model to low-income and other non-majority clients Writing goals Cultural differences and psychodynamic therapy Readings: Mattei, L. (1996). Coloring development: Race and culture in psychodynamic theories. In J. Berzoff, L.M. Flanagan, & P. Hertz (Eds.) Inside out and outside in: Psychodynamic clinical theory in contemporary multicultural context (pp. 221-245). Northvale, NJ: Jason Aronson Press. Wheelock, I. (2000). The value of psychodynamic approach in the managed care setting. American Journal of Psychotherapy, 54(2), 204-215. Wong, E.C., Kim, B.K., Zane, N., Kim, I., & Huang, J.S. (2003). Examining culturally based variables associated with ethnicity: Influences on credibility perceptions of empirically supported interventions. Cultural Diversity and Ethnic Minority Psychology, 9(1), 88-96. Class 5: Psychodynamic and its application with Children and Adolescents Discussion of how to modify techniques and theory with children Differences in use of self Sand tray – example of technique Readings: Brandell, J. (2004). Children. In Psychodynamic social work (pp. 257-291). New York, NY: Columbia University Press. 7 853 Tuesday – Grady 8 Brandell, J. (2004). Adolescents. In Psychodynamic social work (pp. 292-318). New York, NY: Columbia University Press. Plotts, C., Lasser, J., & Prater, S. (2008). Exploring sandtray therapy: Application to individuals with traumatic brain injury. International Journal of Play Therapy, 17(2), 138-153. Class 6: Introduction to CBT JOURNAL ON PSYCHODYNAMIC THERAPY DUE Overview of Cognitive-Behavioral Models of Social Intervention, Basic tenets of the model, assumptions and goals Beck video of CBT Readings: Beck, Chaps 1-4 Beck, A.T. (2005). The current state of cognitive therapy: A 40-year retrospective. Archives of General Psychiatry, 62, 953-959. McGinn, L.K., & Sanderson, W.C. (2001). What allows cognitive behavioral therapy to be brief: Overview, efficacy, and crucial factors facilitating brief treatment. Clinical Psychology: Science and Practice, 8(1), 23-37. Class 7: CBT/Narrative Differences and components Cognitive-Behavioral Models – case formulations and techniques Videotape: Donald Michenbaum “Narrative CBT” Client diversity and impact on interventions Readings: Beck, Chaps 6-10 Eubanks-Carter, C., Burckell, L.A., & Goldfried, M.R. (2005). Enhancing therapeutic effectiveness with lesbian, gay, and bisexual clients. Clinical Psychology: Science and Practice, 12(1), 1-18. Muroff, J. (2007). Cultural diversity and cognitive behavior therapy. In T. Ronen, & A. Freeman (Eds.), Cognitive behavior therapy in clinical social work practice (109-146). New York, NY: Springer Publishing Company. 8 853 Tuesday – Grady 9 Class 8: CBT/Narrative Approach with Children and Adolescents Application of CBT to children and adolescents Modification of language, terms and strategies Readings: Beck, Chaps 14-15 Bloom, B.L. (2002). Brief psychotherapy with children and adolescents: Recent outcome studies. Brief Treatment and Crisis Intervention, 2(3), 261-273. Edelman, S., & Remond, L. (2005). Group cognitive behavior therapy program with troubled adolescents: A learning experience. Family Behavior Therapy, 27(3), 47-59. Ronen, T. (2007). Cognitive behavior therapy with children and adolescents. In T. Ronen, & A. Freeman (Eds.), Cognitive behavior therapy in clinical social work practice (189-211). New York, NY: Springer Publishing Company. Class 9: Intro to SFT Solution-Focused Models of Social Intervention Tenets of Model Miracle Question Readings: de Shaver & Dolan: chapters 1 and 3 Gingerich, W.J., & Eisengart, S. (2000). Solution-focused brief therapy: A review of the outcome research. Family Process, 39(4), 477-498. Pachankis, J.E., & Goldfried, M.R. (2004). Clinical issues in working with lesbian, gay, and bisexual clients. Psychotherapy: Theory, Research, Practice, Training, 41(3), 227-246. Class 10: SFT Techniques and Application Ethnic Differences Skill-Building Exercise in Defining Goals Videotape: Insoo Kim Berg & Norman Rouse on goal setting with substance abusers Techniques Skill-Building Exercise in Finding Exceptions to the Problem, Scaling, Constructing Hypothetical Solutions (“The Miracle Question”), and Constructing Homework Assignments. 9 853 Tuesday – Grady 10 Readings: de Shaver & Dolan: chapters 4 and 9 Chazin, R., Kaplan, S., & Terio, S. (2000). The strengths perspective in brief treatment with culturally diverse clients. Crisis Intervention, 6(1), 41-50. Corcoran, J. (2000). Solution-focused family therapy with ethnic minorities. Crisis Intervention & Time Limited Treatment, 6(1), 5-12. Class 11: SFT: Application to children and adolescents Modification techniques to children and adolescents Inclusion of family in work with children and adolescents Video – “I’d hear laughter” Readings: de Shaver & Dolan: 10 Corcoran, J. (2002). Developmental adaptations of solution-focused family therapy. Brief Treatment and Crisis Intervention, 2(4), 301-313. Nims, D.R. (2007). Integrating play therapy techniques into solution-focused brief therapy. International Journal of Play Therapy, 16(1), 54-68. Reiter, M.D. (2004). The Surprise Task: A solution-focused formula task for families. Journal of Family Psychotherapy, 15(3), 37-45. Class 12: Application of case to all 3 Models Role plays of cases using all three models Critically examine the strengths and limitations of each model Create goals and objectives within each case How do you decide when to integrate or blend models? How to choose among the models? Process of EBP. Readings: Lazarus, A.A. (2005). Is there still a need for psychotherapy integration? Current Psychology: Developmental, Learning, Personality, Social, 24(3), 149-152. Mullen, E.J., Bellamy, J., Bledsoe, S.E. (in press). Evidence-based practice. In R. Grinnel (Ed.) Social work research and evaluation (chp. 25)(8th ed.). New York, NY: Oxford University Press. 10 853 Tuesday – Grady 11 Schottenbauer, M.A., Glass, C.R., & Arnkoff, D.B. (2007). Decision-making and psychotherapy integration: Theoretical considerations, preliminary data, and implications for future research. Journal of Psychotherapy Integration, 17(3), 225-250. Winston, A., & Winston, B. (2001). Toward an integrated brief psychotherapy. Journal of Psychiatric Press, 7, 377-390. Class 13: Crisis Intervention JOURNAL ON SFT THERAPY DUE Crisis Intervention Psychological First Aid Suicide Prevention Readings: Cunningham, M. (2000). Spirituality, cultural diversity and crisis intervention. Crisis Intervention, 6, 65-77. Roberts, A.R. & Ottens, A.J. (2005). The seven-stage intervention model: A road map to goal attainment, problem-solving, and crisis resolution. Brief Treatment and Crisis Intervention, 5(4), 329-339. Vernberg, E.M., Steinberg, A.M., Jacobs, A.K., Brymer, M.J., Watson, P.J., et al. (2008). Innovations in disaster mental health: Psychological First Aid. Professional Psychology: Research and Practice, 39(4), 381-388. Class 14: Course Wrap-up Termination – How to know when to terminate? Dilemmas faced in brief treatment Course wrap-up Remaining questions Readings: Mander, G. (2003). Dilemmas in brief therapy. Psychodynamic Practice, 9(4), 485-500. 11 853 Tuesday – Grady 12 APPENDIX A Brief Therapy Paper Assignment Objective: The objective of this paper is to solidify students’ knowledge of the three major modalities of treatment by applying the concepts from this course to a case. Description of Assignment: 1. Take one of your cases that you have had either in your field or previous work/volunteer experiences. 2. Give a brief description of the case (1-2 pages) that includes a brief history, current life situation, and presenting problem, and any other relevant information that you deem appropriate. 3. Apply each of the following models to that case: Solution-focused Therapy; CognitiveBehavioral Therapy; and Psychodynamic Therapy (approximately 2-3 pages on each model). This application includes: a. A formulation of the case using the models (how would the model describe the problem/situation ), and b. List 3 treatment goals that would be appropriate for the client, using the language and perspective of the model. 4. After you have described the models, choose one that you think is the best fit for this case and give your rationale for why you would approach the case from that perspective. This discussion should include the three evidence-based process components: a. Outcomes studies that fit for the case/situation (from class readings and other sources at least 5 total) b. Your fit with a particular model and what you would bring to the case c. Issues of client specificity: intelligence level; patterns from the past; what worked or hasn’t worked for them before; etc. Grading Criteria: 1) The case example well written (5 points). 2) Each model of treatment applied accurately and clearly. There a clear case formulation using each model (10 points for each model = Total of 30 points) 3) The goals for each model fit the language of the model AND address the presenting problem (5 points for each model = Total of 15 points) 4) The student advocated for the use of one model clearly, using the three areas of EBP criteria for the basis of their position as listed in #4 of paper description (10 pts for each section = Total of 30 points) 5) Appropriate number of references are used, in APA format and well utilized in the paper (10 points) 6) The document reflects an understanding of various dimensions of diversity as they may apply to the assessment, goals, intervention and evaluation. (5 points) 7) The document is well written, uses nonjudgmental language and demonstrates basic mastery of sentence structure, with no errors in spelling, punctuation, grammar or typing. (5 points) 12 853 Tuesday – Grady 13 APPENDIX B JOURNAL DESCRIPTION AND GRADING CRITIERIA Objective: The purpose of the journal is to convey familiarity with class material and to then communicate how it is informing your thinking about either professional or personal experiences. Description of Assignment: The journal assignment is a 4-5 page reaction paper in which you reflect on the unit covered both through class lecture, discussion, reading, and/or class activity. The goal is for me to hear from you how you understand the model, what you see as its strengths/limitations, and how you feel it fits for you and WHY. What do you like about it? What don’t you like about it? Could you imagine using it? In what circumstances? Contents should include the following: 1. A brief summary of the model (What are its basic assumptions/tenets?). 2. What are its strengths and limitations? 3. Is this model a good fit for my belief system, personality, and intended client population? 4. Any remaining questions about the model. Grading Criteria: This assignment is worth 15 points each and will be evaluated on the following criteria: 1. The journal clearly summarizes the model and its basic tenets (5 points). 2. The strengths and limitations of the model have been discussed (3 points.) 3. The student has discussed how the model fits for him/her and why. Could you imagine using this model? When, where, why and with whom? (5 points). 4. Journal is well written and clearly organized (2 points). Things to consider before writing your journal: What reading material or class activity has stood out for me, (or surprised me, interested me)? How has it made me feel? What has my reactions, opinions thoughts about it? How does this information or perspective relate to my field practice experience or other professional experience? How does this information or perspective relate to my own life experience? How might this material help to inform a case that I have or my work in general? How might I apply this information in my practice? What are the strengths and weaknesses of this model? How would it be a good fit for certain populations and not others? 13