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Final Synthesis Paper
School of Social Work | Watts College of Public Service and Community Solutions
Arizona State University
SWG 693: Applied Project
Dr. Michelle Beyers
June 24, 2022
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Final Synthesis Paper
Introduction
This MSW student’s field placement was conducted at Yuma Counseling Services, an
outpatient mental health facility. The student’s main responsibilities included conducting
long-term individual, couples, and family counseling. Further duties included assessment and
treatment planning, and organizing and presenting to the public.
The three activities this MSW student outlined are assessment and treatment planning,
therapy sessions, and facilitating an educational parent night on ADHD. Within this paper, the
MSW student will describe each activity, what the student’s role was, and what were the
student’s contributions to the activity. The micro and mezzo levels of intervention will be
addressed. In addition, the student will discuss the Educational Policy and Accreditation
Standards (EPAS) that aligns with each project. These standards, used by the Council on Social
Work Education (CSWE), ensure the MSW student is aligning their field experience with the
accredited MSW program’s curriculum (CSWE, 2015, pg. 4). Lastly, in each section, the MSW
student will present a self-reflection on why they chose the activity, how it contributed to their
learning, and rating their acquired skills on a 1-10 scale.
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Project Activity #1: Assessment and Treatment Planning
Project Description
The MSW student conducted a biological, psychological, and social assessment
(biopsychosocial). This is a collection of ecological data. The ecological perspective claims that
a person is profoundly influenced and affected by the environment in which they live (Holosko,
Dulmus, C. N., & Sowers, K. M., 2013). A biopsychosocial assessment addresses how a person’s
biology, psychological landscape, and social network impact their lives in both adaptive and
maladaptive ways. The student used a biopsychosocial assessment tool to help guide the session
and cover all necessary information pertinent to counseling services. This was the initial stage in
building rapport with the client. The student later collaborated with their clinical supervisor to
help advise treatment planning.
Description of Theory Application
The MSW student engaged with the client following a narrative theory framework. The
narrative theory claims that when social workers engage an individual to learn about their current
worldview, it is here that clinicians work with the client to understand how certain factors such
as society and culture influence their perspective, ultimately attempting to re-author maladaptive
perspectives (Roscoe, Carson, A. M., & Madoc-Jones, L., 2011). From our initial experiences,
we form a narrative that informs our self-esteem, relationships, and self-efficacy and because we
carry multiple stories at once, it can have a negative impact on our wellbeing; narrative theory
attempts to create alternative meanings that create peace for the client.
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Narrative therapy’s central tenets include: telling one’s story, externalization,
deconstruction, and unique outcomes (Roscoe, et al., 2011). The initial engagement between the
social worker and client allows the individual to establish the current storyline of their life. This
is the initial stage of creating meaning. The social worker will then help the client externalize
their situation by using phrases like “the guilt,” or “the fear.” This experience helps the client
create distance between their experience and their identity association with it. Once the client can
learn their story doesn’t mean it is their identity, they can begin deconstructing how it began,
leading to a unique outcome (re-authoring) that provides relief from their suffering.
Analysis of Theory Application
Conducting the biopsychosocial assessment, this MSW student engaged the client in
sharing their story, the first tenet of narrative therapy. At this stage, the MSW student used active
listening to ensure the client felt heard in sharing their story, asking clarifying questions, and
re-stating the client’s words in an attempt to best understand how the client views their
presenting issue. For example, the client seeking services during this activity stated he was
struggling with negative beliefs and feelings associated with childhood sexual trauma. He was
interested in easing the impact of this experience both psychologically and interpersonally. He
had developed negative beliefs about himself with regards to self-worth and self-esteem, mistrust
in relationships, and anger. It was during the assessment that this student and client established
that this event would be the therapeutic focus with the goal of re-authoring his story.
In understanding the cultural influences impacting the client’s experience of his story, the
MSW student asked questions about how the client’s race, gender, and family dynamics impact
his experience. Specifically, the client is a Mexican male who stated topics like abuse are not
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discussed in general in his culture, but especially because he’s a man, he learned it is forbidden
to admit such acts took place. As such, the student and client were able to identify external
factors shaping the client’s perceptions. The MSW student used critical thinking to educate the
client on the concepts of deconstructing and re-authoring, indicating how their story fits into this
approach.
Strengths and Limitations
Using narrative theory during the biopsychosocial assessment provided helpful in making
the client feel understood, as he had not told anyone of his experience before. He stated he had
never thought to look at his life in a different way. He stated the thought of it made him feel
hopeful. This approach has pragmatism built-in, which helps wade through the complexity of a
person’s life story. For example, framing the client’s experience as external, or naming elements
that have influenced his perceptions, created an opportunity to name an otherwise confusing
experience, allowing him to feel more in control.
Limitations consist of creating meaning out of violent situations. Considering the client is
seeking help from the abuse they suffered, creating meaning out of a violent act proves
challenging as the client is left not knowing why it happened or what influenced the attacker to
do what they did. Another limitation is the MSW student’s lack of adequate training in the theory
and method. The student felt they needed a more robust understanding of how to weave meaning
into the client’s complex experiences, this would require more investment as opposed to a
quicker learned and applied intervention.
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Intervention Level
Assessment and treatment planning are conducted at the micro-level of social work
intervention. Micro-level involves “...working clinically with individuals, families, or very small
groups. Its essence is to engage directly, deeply and extensively, for the purpose of facilitating
changes in individual behavior or relationships” (Ebue, Uche, and Agha, 2017). Because the
MSW student directly conducted the assessment with the client for the purpose of facilitating
some change in the individual, it is considered a micro intervention.
Core Competency
The assessment and treatment planning activity falls under EPAS: Competency 7: Assess
Individuals, Families, Groups, Organizations, and Communities. Here this MSW student
collected and organized data applying critical thinking to interpret client information, applied
knowledge of person-in-environment (PIE) and other multi-disciplinary frameworks in the
analysis of client information, worked with the client to develop mutual goals and objectives
based on strengths, needs, and challenges within the client, and selected appropriate
interventions based on research and values and preferences of the client (CSWE, 2015).
Self-Reflection
The MSW student chose this activity because it is an essential part of clinical social
work, which will be the student’s area focus after graduation. The student learned how to
integrate the sections of the assessment in a conversational manner during the session. The
student learned to listen to how the presenting problem impacts the client’s life and the various
external factors contributing to the issue. The MSW student learned how to use the various data
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points, specifically from the history of presenting the problem to help formulate a diagnosis. The
student developed the following skills: active listening, cultural competence, and critical
thinking. The student used affirming body language, and an empathetic tone of voice, and
restated and summarized during active listening. Cultural competence was practiced as the
client’s familial beliefs impacted his presenting problem, and critical thinking was used to
develop an appropriate course of treatment on the treatment plan. .
Table 1
Development of Practice Skills and Self-Assessment
Skill Identification
Proficiency Self-Rating – Before
Proficiency Self-Rating - After
Active listening
7
8
Cultural competence
5
6
Critical thinking
7
7.5
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Project Activity #2: Individual Therapy
Project Description
The MSW student held the role of the therapist during an individual therapy session. The
student used a worksheet from a Dialectical Behavior Therapy (DBT) workbook. DBT is a
therapeutic model to address the following: mindfulness, emotional regulation, distress tolerance,
and interpersonal effectiveness (Van Dijk, 2021). The MSW student selected an activity called
What is Mindfulness (Davis & Hayes, 2011), and Emotion Regulation Skills (Berking,
Wupperman, Reichardt, Pejic, Dippel, & Znoj, 2008). The client was 13 years old and had
difficulty with harsh self-judgments and regulating her anger. To add relevancy, the MSW
student discussed how the activity would relate to the client’s life.
As this was the fourth session, there were previous activities done to build rapport, such
as question and answer card games, relevant self-disclosure, and psycho-education on the nature
of the counseling relationship and confidentiality. Aside from staffing the client’s case with the
student’s clinical supervisor, a delicate relationship was needed with the parents, too. This
student met with the parents to discuss how they could support their daughter, without giving too
much information in order to maintain the client’s privacy.
Description of Theory Application
DBT is based on behavioral and cognitive theories aimed at addressing a range of mental
health symptoms, focusing on how emotional regulation is at the forefront of such symptoms, in
addition, the aim is to create skill acquisition in mindfulness, interpersonal effectiveness, and
distress tolerance (Chapman, & Dixon-Gordon, 2020). Emotional regulation skills are to improve
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the client’s awareness of their emotions, paying specific attention to how environmental factors
influence their moods. Mindfulness is taught to help clients create space to choose behaviors and
live presently instead of following the whim of their emotions. Interpersonal skills are taught to
help clients improve their ability to maintain changing relationships. This can look like
advocating for one’s needs, saying no, and being empathetic. Lastly, distress tolerance skills help
clients get through crisis-type situations where they can choose behaviors that help, not further
hurt the client. These can look like distractions, self-soothing, or focusing on small ways to
improve the present moment (Chapman, et al., 2020).
Analysis of Theory Application
The client’s presenting problem involved having trouble managing her explosive anger.
This student practiced connecting theory to practice. The theory states individuals develop
maladaptive ways to meet their needs, and addressing the following helped bridge underpinning
to practice: mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance
could all be addressed to effectively intervene with the client’s anger (Chapman, et al., 2020).
Mindfulness was taught to help the client become aware of her physical sensations before,
during, and after feeling angry. She was taught to use her breath to decrease her physical arousal
while angry. The MSW student practiced patience in working alongside the client’s resistance to
learning this skill. Patience helped the student find alternative approaches to teaching mindful
breathing. She learned how to regulate emotion by identifying triggering events, assumptions
placed on the event, and identifying if her emotion matches the facts of the event (Van Dijk,
2021). She practiced communicating with others, namely her parents, by identifying her wants
and feelings, being clear with expectations, asserting positive outcomes, being mindful of tone
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and body language, and being willing to negotiate. Lastly, DBT helped the client to learn how to
tolerate distressing things by acknowledging her feelings about the unpleasant event but
accepting the outcome, weeding out negative statements about blaming herself or others for the
outcome. There were many topics covered during the session and this MSW student had to
practice the skill of communication by making the information digestible so as to not lose or
overwhelm the client.
Intervention Level
Individual therapy falls under the micro-level of intervention. Ebue et al. (2017) state
social workers at the micro level need to know not just about the individual, but the
interpersonal, family, group dynamics, and environmental influences that impact the client. From
this definition, the MSW student discussed the client’s status with friends, their life at school,
relationships with parents and siblings, and any life changes they were dealing with. In this case,
the client’s parents were separating, the client’s grades were lower than usual, and there was
strife within a friend group. DBT was useful in this case as the client was having difficulty
accepting the changes in her life; DBT supports that “balancing acceptance and change…and
building key behavioral skills” can lead to a regulation of emotion (Chapman, Dixon-Gordon,
2020).
Core Competency
This intervention falls under Competency 8: Intervene with Individuals, Families,
Groups, Organizations, and Communities. This competency focuses on evidence-informed and
theory-based interventions to help clients achieve their goals (CSWE, 2015). It also discusses the
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importance of inter-professional teamwork. This MSW student met this competency because
DBT is both evidence and theory-based, and there was a collaboration with other clinicians and a
clinical supervisor to achieve beneficial practice outcomes (CSWE, 2015). Competency 8 also
requires this MSW student to “facilitate effective transitions and endings that advance mutually
agreed-on goals” (CSWE, 2015), at the beginning of the session there was a re-cap of where the
last session left off, a re-statement of how it relates to the treatment plan, and at the end,
checking in to see if the client felt the activities during the session matched their expectations for
achieving their goals.
Self-Reflection
The activity facilitated the MSW student’s learning as being helpful in connecting theory
to practice. The worksheet served as a tangible guide of DBT interventions instead of the student
creating their own and possibly missing pieces of the intervention. The worksheet also provided
an opportunity for further communication as the client attempted to apply the material to their
life in a practical way. The MSW student asked probing questions based on the worksheet, which
led to richer discussions. Lastly, patience was needed as the client initially answered, “I don’t
know” to the questions, so ample “think time” and allowing the client to move and return proved
helpful.
Table 2
Development of Practice Skills and Self-Assessment
Skill Identification
Proficiency Self-Rating – Before
Proficiency Self-Rating - After
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Connecting theory to
6
7
Patience
8
9
Communication
7
8
practice
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Project Activity #3: ADHD Parent Night
Project Description
The psychoeducation parent night presentation required the MSW student to create a
presentation that was research aligned, ensure the language was digestible, prepare marketing
material, appropriately manage time and organize an accommodating physical space, provide
parents with take-home material of the presentation, which included how to sign their children
up for the ADHD neuro-feedback intervention, and answered parents’ questions and concerns.
One main purpose of this event was to build relationships with parents. With feedback from
other clinicians and this student’s own experiences, parents often frustrated with their current
interventions felt confused and had trouble seeing beyond their children’s problematic behavior.
This is why a strengths perspective guided the presentation, which states it, “...seeks to identify,
use, build on, and reinforce the abilities and strengths that people have, in contrast to the
pathological perspective, which focuses on their deficiencies" (Zastrow & Hessenauer, 2018).
Description of Theory Application
A strengths perspective seeks to identify, use, and build upon strengths people already
possess, emphasizing abilities, interests, aspirations, beliefs, resources, and accomplishments
(Zastrow & Hessenauer, 2018). There are five principles guiding a strengths perspective
approach: every individual, group, family, and community has strengths; trauma, abuse, illness,
and struggle can be an opportunity, not just struggle; have undefinable high expectations;
collaborate with clients, and look to the environment for resources.
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Analysis of Theory Application
The principle of assuming individuals, groups, families, and communities possess
inherent strength was a theme for the presentation. Mainly this focused on the individual (the
child with ADHD) and the family. This student sought to show parents the neuro-feedback
intervention would build upon the autonomy their children already have. The parents learned the
skills taught in the intervention can be practiced and reinforced at home within their typical
schedule, it was even suggested parents could participate in the same mindfulness skills taught to
their children through the intervention. The MSW student sought to frame their children’s
internal and interpersonal struggles, and experiences of feeling outcasted as opportunities for the
children to practice resiliency, acceptance, patience, and management of expectations, all skills
taught with the neuro-feedback intervention. One aspect of the intervention is working with the
client and their parents to create a reward system that changes, as the child continues to make
progress in the intervention and at home and school, the rewards continue to increase in impact.
This helps the child see that they can attain what they want through action. Part of the night was
to create a safe space for parents to share their stories, ask questions, and meet other parents,
thereby allowing this MSW student to practice empathy. There was a time in the end for
questions and for parents to share success stories and struggle stories. This student practiced the
skill of organization as a presentation was created, seating arranged, and the meeting was
time-bound. Lastly, the student practiced boundary setting as there were times in the night that
parents wanted to explore topics that, while important, were not at the appropriate time or on the
topic of the neuro-feedback intervention. The student had to redirect their attention back to the
topic.
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Intervention Level
This activity is an example of mezzo-level intervention. Ebue et al, (2017) state this level
of intervention happen within small to medium-sized groups targeted for people to function more
effectively within the group or specific population. The group in this activity were parents who
have children with an ADHD diagnosis. Though the group was education-based, connections
among parents and networking took place, providing them with experiences of belonging and
problem-solving; which Ebue et al., (2017) say as bringing individual members together. The
aim was to provide parents, who have voiced their previous treatment has been deficit-based,
with a treatment option that emphasizes their children’s strengths. The idea was to re-engage
parents who felt lost in helping their children, with education and treatment options that would
ignite optimism. Since their children lack the exact skills needed to be successful in school, and
executive functioning, they may have had “frequent experiences of negative feedback,
frustration, and failure (Climie & Mastoras, 2015). Thus the need for a refreshed perspective on a
commonly misunderstood diagnosis.
Core Competency
The ADHD parent night falls under EPAS Competency 2: Engage Diversity and
Difference in Practice. This competency highlights how social workers need to understand how
an individual’s diversity profoundly shapes their identity (CSWE, 2015). As stated before, it was
this MSW student’s intention to communicate that their child’s diversity has marginalized them,
requiring interventions to address how these differences can actually be seen as positive
attributes, instead of something they feel alienated by. While this MSW student was the
facilitator of the group, the aim was to present the student as a learner and engage the parents as
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experts of their experience (CSWE, 2015). The student attempted to use language that did not
further alienate the parents or perpetuate stereotypes (CSWE, 2015).
Self-Reflection
This project was chosen by the MSW student to engage with a population from a mezzo
level of intervention. Up to that point, the student had only engaged with individuals at the
micro-level and this presentation afforded an opportunity to practice addressing a specific
population as a group. Being that this student had previous experience designing presentations
and addressing groups, particularly parents, the newest learning took place in hearing the
emotional impact of years of interventions that did not seem to have the intended impact.
Hearing these stories helped this MSW student understand the nuances of how ADHD impacts a
child. Skills developed during this activity are organization, empathy, and boundary setting to
manage expectations.
Table 3
Development of Practice Skills and Self-Assessment
Skill Identification
Proficiency Self-Rating – Before
Proficiency Self-Rating - After
Organization
7
7.5
Empathy
8
8.5
Boundary setting
5
6
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Concluding Reflection
This paper covered this MSW student’s three most prominent field experiences. The
activities of assessment and treatment planning, individual therapy, and the ADHD parent night
were described by which tasks were completed, skills developed, competencies aligned, and
what their social work intervention level was. Each section connected the student’s activities to
research that supported the interventions. Lastly, the student took time to reflect on what was
learned with each activity, what skills were gained, and how the student felt about their abilities.
The theories outlined in this paper are Narrative Theory, Dialectical Behavior Therapy,
and Strengths Perspective. Narrative theory was useful overall during the biopsychosocial
assessment as it helped this student and their client comes to an understanding of what influences
their perspective on life and how they would like to ideally view life. DBT was practical in its
use and provided this student with confidence as there are many activities within DBT and skills
to continually build upon. The strengths perspective during the community event felt fitting as
parents left the meeting stating they felt energized and hopeful; consequently, several parents
signed up their children to receive the intervention.
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