KENNESAW STATE UNIVERSITY
GRADUATE COURSE PROPOSAL OR REVISION,
Cover Sheet (10/02/2002)
Course Number/Program Name SW 8702 / Social Work
Department Social Work and Human Services
Degree Title (if applicable) Master of Social Work
Proposed Effective Date August, 2012
Check one or more of the following and complete the appropriate sections:
New Course Proposal
Course Title Change
Course Number Change
Course Credit Change
XXCourse Prerequisite Change
XX Course Description Change
Sections to be Completed
II, III, IV, V, VII
I, II, III
I, II, III
I, II, III
I, II, III
I, II, III
Notes:
If proposed changes to an existing course are substantial (credit hours, title, and description), a new course with a
new number should be proposed.
A new Course Proposal (Sections II, III, IV, V, VII) is required for each new course proposed as part of a new
program. Current catalog information (Section I) is required for each existing course incorporated into
the program.
Minor changes to a course can use the simplified E-Z Course Change Form.
Submitted by:
_____
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KENNESAW STATE UNIVERSITY
GRADUATE COURSE/CONCENTRATION/PROGRAM CHANGE
I.
Current Information (Fill in for changes)
Page Number in Current Catalog
___
Course Prefix and Number SW 8702
___
Course Title Advanced Clinical Practice I: Working With Individuals
___
Class Hours
3 ____Laboratory Hours_____0__Credit Hours____3____
Prerequisites Admission to the MSW Program
Description (or Current Degree Requirements)
___
This advanced practice course will build upon basic skills covered in the foundational
year practice sequence. It is designed to increase knowledge and understanding essential
for effective therapeutic interventions in psychological and behavioral disorders. This
course builds upon the foundation year courses by expanding the conceptual dynamics of
the ecological perspective related to individuals. Topics will include advanced clinical
interventions with individuals using multiple theoretical orientations and models.
Formulation of intervention strategies will employ multiple research-based techniques.
Assessment of intervention effectiveness is central to this course.
II.
Proposed Information (Fill in for changes and new courses)
Course Prefix and Number ___________________________________
Course Title _________________
___________
Class Hours
____Laboratory Hours_______CreditHours________
Prerequisites All MSW Foundation Level Courses
Description (or Proposed Degree Requirements)
This Advanced Clinical Practice I: Working with Individuals course builds upon basic skills
covered in the first year foundation practice, human behavior and the social environment,
policy, research courses and field experiences. The course will assist students with
specializations in Child and Family Services, Mental Health and the subspecialty,
Substance Abuse, in their assessment and intervention with individuals
III.
Justification
Course Updated to be in compliance with the accreditation standards.
IV.
Additional Information (for New Courses only)
Instructor:
Text:
Prerequisites:
Objectives:
Instructional Method
Method of Evaluation
-
V.
Resources and Funding Required (New Courses only)
Resource
Amount
Faculty
Other Personnel
Equipment
Supplies
Travel
New Books
New Journals
Other (Specify)
TOTAL
Funding Required Beyond
Normal Departmental Growth
VI. COURSE MASTER FORM
This form will be completed by the requesting department and will be sent to the Office of the
Registrar once the course has been approved by the Office of the President.
The form is required for all new courses.
DISCIPLINE
COURSE NUMBER
COURSE TITLE FOR LABEL
(Note: Limit 30 spaces)
CLASS-LAB-CREDIT HOURS
Approval, Effective Term
Grades Allowed (Regular or S/U)
If course used to satisfy CPC, what areas?
Learning Support Programs courses which are
required as prerequisites
APPROVED:
______________________________________________
__
Vice President for Academic Affairs or Designee __
Current Syllabus
MASTER OF SOCIAL WORK PROGRAM
SW 8702: Advanced Clinical Practice I: Working with Individuals
Professor:
Dorcas D. Bowles
Meeting Time:
TBA
Semester Credits:
3 hrs.
Email Address:
dbowles3@kennesaw.edu or
dorcasbowles@bellsouth.net
Phone Number:
678-797-2453
Office:
Room 3323 Prillaman Hall
Office Hours:
Mondays: 10:00am – 12 Noon and 1:00pm –
3:00pm Tuesdays 9:00am-1:00pm or by
appointment
COURSE DESCRIPTION
This advanced practice course will build upon basic skills covered in the foundational
year practice sequence. It is designed to increase knowledge and understanding essential
for effective therapeutic interventions in psychological and behavioral disorders. This
course builds upon the foundation year courses by expanding the conceptual dynamics of
the ecological perspective related to individuals. Topics will include advanced clinical
interventions with individuals using multiple theoretical orientations and models.
Formulation of intervention strategies will employ multiple research-based techniques.
Assessment of intervention effectiveness is central to this course.
COURSE OVERVIEW
Social Work 8702: Advanced Clinical Practice I: Working with Individuals will begin
with a discussion of the meaning of theory and the history of clinical social work. The
course will then cover the major clinical practice theories that social workers
commonly use in their assessment, planning, and intervention with individuals in
either of the two specializations- Children and Family Services or Mental Health and
the subspecialty, Substance Abuse. The practice theories covered include:
psychodynamic theories, including object relations and ego psychology; behavioral;
cognitive; interpersonal; structural family; narrative; time limited dynamic; and
motivational.
Additionally, there will be a discussion of personality disorders, also known as
character disorders, with a special emphasis on borderline and narcissistic
personalities. Spirituality and social justice issues, as defined by each of these
theories, will be infused as the various theories are discussed. The course is designed
to increase knowledge and understanding essential for effective therapeutic
interventions in psychological and behavioral disorders. Other topics will include:
ethics and values, the importance of the therapeutic relationship, diversity and
cultural factors, and the issues involved in terminating with clients. Formulation of
intervention strategies will employ multiple research techniques based on the
theories addressed. Assessment of intervention effectiveness is central to this course.
Prerequisites: All first year foundation courses including first year field internship.
Required Textbooks
Walsh, J. (2006). Theories for Direct Social Work Practice. Belmont, CA: Brooks/Cole.
Berzoff, J., Flanagan, Laura M., and Hertz, P. (2008). Inside Out and Outside In (2nd Ed.
New York: Jason Aronson.
Handouts: Handouts and additional readings will be distributed throughout the
term and/or placed on reserve in the library. Students who are absent from a
particular class are responsible for obtaining the handouts and additional readings
from the instructor.
COURSE RATIONALE RELATIVE TO THE MISSION OF THE MSW PROGRAM
The Master of Social Work Program at Kennesaw State University was established to
address increasing problems in the following specialization areas: Children and
Family Services and Mental Health Services including a subspecialty in Substance
Abuse. The Department is committed to making a positive difference in the
community in these areas. SW 8702 is related to and consistent with the mission of
the Masters of Social Work.
Course Objectives
Upon completion of the course, the student in specializations Children and Family
Services, Mental Health Services and the subspecialty Substance Abuse will be able
to:
SW 8702: Advanced Clinical Practice I: Working with Individuals
Knowledge Objectives: Upon Completion of this course students will:
1. Demonstrate knowledge and understanding of various theories and models
utilized in the clinical treatment of individuals and how to differentially apply
them to diverse populations; EP 2.1.3
2. Demonstrate knowledge and understanding of the importance of diversity in
one’s work with clients; EP 2.1.4
3. Demonstrate knowledge and understanding of how oppression and
discrimination impact clients; EP 2.1.5
4. Demonstrate knowledge of culturally responsive relationships; EP 2.1.10a
Engagement
5. Demonstrate knowledge and understanding of the bio-psychosocial-spiritual
factors that influence clinical interventions; EP 2.1.10b Assessment
6.
Demonstrate a theoretically informed knowledge base to ensure effective
practice interventions with individuals; EP 2.1.10c Intervention
7. Demonstrate knowledge that will allow for the evaluation of one’s work with
clients. EP 2.1.10d
Skills Objectives
1. Demonstrate solid professional identity as a social worker; EP 2.1.1
2. Demonstrate ability to apply ethical decision making skills to specific issues as
they relate to clients served while recognizing and managing one’s personal
biases; EP 2.1.2
3. Demonstrate ability to assess the strengths and weaknesses of a range of
theories and differentially apply them to diverse client situations; EP 2.1.3
4. Demonstrate ability to communicate professional judgments and collaborate
with professionals from various disciplines in coordinating treatment
interventions in one’s work with clients from diverse backgrounds; EP 2.1.3
5. Demonstrate ability to differentially apply theories of human behavior and the
social environment to guide one’s clinical assessments, interventions and
terminations with clients; EP 2.1.7
6. Demonstrate ability to engage, assess, intervene, and evaluate individuals
from diverse backgrounds based on an understanding of their strengths and
resources; EP 2.1.10 a-d
Values Objectives
1. Appreciate and understand one’s personal and professional values, ethical
principles, and legal mandates pertinent to one’s clinical practice with
individuals; EP 2.1.2
2. Engage in self-reflection in the interest of clients served from diverse
backgrounds; EP 2.1.3
3. Recognize client strengths, coping strategies, vulnerabilities and spirituality in
making assessments and interventions EP 2.1.10 b, c
Practice Behaviors that correspond with the course objectives and the ten
advanced competencies
1. Readily identify as a social work professional EP 2.1.1
2. Demonstrate professional use of self with client/s; EP 2.1.1
3. Apply ethical decision-making skills to issues specific to clinical social work
EP 2.1.2
4. Engage in reflective practice EP 2.1.3
5. Identify and articulate clients’ strengths and vulnerabilities EP 2.1.3
6. Research and apply knowledge of diverse populations to enhance client
well-being EP 2.1.4
7. Use knowledge of the effects of oppression, discrimination, and historical
trauma on client and client systems to guide treatment planning and
intervention EP 2.1.5
8. Synthesize and differentially apply theories of human behavior and social
environment to guide clinical practice EP 2.1.7
9. Assess the quality of clients’ interactions within their social contexts EP
2.1.9
10. Develop a culturally responsive therapeutic relationship EP 2.1.10a
Engagement
11. Use multi-dimensional bio-psychosocial spiritual assessment tools EP
2.1.10b Assessment
12. Collaborate with other professionals to coordinate treatment interventions
EP 2.1.10c
13. Use clinical evaluation of the process and/or outcomes to develop best
practice interventions for a range of bio-psychosocial spiritual conditions
EP 2.1.10d
COURSE METHOD
Didactic presentations/discussions, analysis of videotapes, case discussions, and role
playing, will be used throughout the semester. Students are expected to have read
assignments and cases prior to a given class and should be prepared to participate in
classroom discussions and role plays. Students will not be able to participate in
experiential exercises and class discussions unless they are present in class.
Therefore, class attendance and participation are imperative.
COURSE EXPECTATIONS
Attendance Policy: Students are expected to attend each and every class and to
arrive on time,. Roll will be taken regularly. Students are allowed to miss two classes
without penalty. Three (3) points will be deducted from the final score if one misses
3-5 classes and 5 points will be deducted if one misses 6 or more classes. Students do
not need to notify the professor regarding the reason for their absence(s). Be aware
that tardiness will also affect your final grade
Phones/Pagers: . Phones and pagers disrupt the class. Phones and pagers must be
turned off during class.
Make-up Policy: Make-up exams or extension dates on papers, as a rule, will not be
permitted. Only in extraordinary circumstances may this be considered
((hospitalizations, death of a family member, etc.). The professor reserves the right
to determine the format of any make-up exam or extension dates on papers.
Incomplete Grades: The grade of “I” will be given only under emergency situations
that prohibit a student from completing specific assignments or class projects. The
student must contact the instructor and receive approval in writing that an
assignment cannot be completed by the designated date so that the grade of “I” can
be given for incomplete work. A designated time will be given by the professor for
when the work must be completed by the student. If the deadline is not met, the
student will receive a grade based upon work completed for the course excluding a
grade for the specific assignment.
Assignments Policy: All papers must be completed using APA 6th edition
(see www.apastyle.org). That includes, but is not limited to, using double-spacing, as
well as standard fonts (Times New Roman 12) and margins (1 inch on all sides).
Page number requirements do not include the cover page, reference pages or
appendices. While references can be used from a number of sources, references
counted as “required” include only peer reviewed journal articles or book chapters
published from a scholarly press (Columbia University Press, Jason Aronson Press,
Allyn Bacon , etc. ). Other references may be used, however they do not count as a
required references. Late assignments will be penalized as follows: 2 days late – 5
points ; 3-4 days late 10 points; 5 – 7 days late 15 points. Papers will not be accepted
after 7 days.
Communication with Students: All communication with students will be through
KSU e-mail address so that you should check your e-mail regularly.
ACADEMIC INTEGRITY STATEMENT
http://catalog.kennesaw.edu/content.php?catoid=11&navoid=489&returnto=search
#stud_code_cond
Criteria for Student Evaluation
Progress will be evaluated utilizing the following criteria:
Class attendance and participation Three (3) points will be deducted from the final
score if one misses 3-5 classes and 5 points will be deducted if one misses 6 or more
classes.
Assignment
Assignment 1:
Assignment 2:
Assignment 3:
Assignment 4:
Total = 100%
Topic
Ethical Dilemma
Antwone Fisher
Psycho. Application Case of Susan
CBT, Psycho-Dynamic, or
Interpersonal Application Case of
Alice
Due
9/6/2011
9/27/2011
10/18/2011
11/22/2011
Points
100 points
100 points
100 points
100 points
Course grades will be assigned as follows:
Percentages for Final Grade
92 – 100%
A
91 - 80%
B
79 - 70%
C
69 and Below
F
Course Outline and Readings
Weekly Topics and Readings:
1. Week 1: August 23, 2011
Setting the Stage:
Definition & History of Clinical Social Work; Practice Theory
What is Theory?
The Relationship between Theory and Intervention
The value of theory in Clinical Practice
The Curative Factors in all Practice Theories
Strengths Oriented Clinical Practice; Spirituality
Evidence-based Practice
Ecological Systems Theory (ecosystems)
Becoming a Therapist
DVD: Becoming a Therapist: Inside the Learning Curve from Psychotherapy.
Net
Required Reading:
*Walsh, J. Chapter 2, pp. 17 – 31. (Strengths Oriented Clinical Practice, pp 19-21;
Incorporating Spirituality into Direct Practice – pp. 29-30).
*Cowger, Charles D. and Snively, Carol A., “Assessing Client Strengths” (On Reserve in
Library)
*Borden, W. (2009). Evidence-Based Practice, Science and Social Work: An Overview.
In Roberts & Greene (Eds.) Social Worker’s Desk Reference, pp. 1115-1120.
Oxford Press. (On reserve in Library.)
*Borden, W. (2009). The Life Model/Ecological Perspective. In Roberts & Greene
(Eds.) Social Worker’s Desk Reference, pp. 231 – 235.. Oxford Press. (On
reserve in Library)
Rothery, Michael ( ) “Ecological Systems Theory. (On Reserve in Library)
Optional Reading:
•
Goldstein, H. (1990). The knowledge base of social work practice: Theory,
wisdom, analogue, or art? Families in Society, 71, 32-43.
•
Saleebey, D. (2000). Power in the people: Strengths and hope. Advances in Social
Work, 1(2), 127-136.
2. Week 2: August 30, 2011
Ethics and Values in Clinical Social Work
Clinical Vignettes of Ethical Issues Provided by Professor for Class Discussion.
Assignment I: Ethical Dilemma Assignment Due Week 3: September 6, 2011
1. Describe an ethical dilemma you have experienced or know about from your
social work experience (25 points).
2. What action did you take regarding the ethical dilemma? (25 points)
3. Identify and discuss the relevant ethical guidelines as described in the NASW
Code of Ethics. (25 points)
4. Given the ethical guideline(s) discussed, did you take the appropriate action
or would you, in hindsight, take a different action? (25 points)
Required Reading:
NASW Code of Ethics
Reamer, F.G. (1998). The evolution of social work ethics. Social Work, 43, 488-500. (
In Library or can be obtained from University of Georgia SSW or Georgia State
U. SSW)
Borden, W. (2009). Ethical Issues in Social Work.. In Roberts & Greene (Eds.) Social
Worker’s Desk Reference, pp. 115 - 121. Oxford Press. (Available to copy from
Dr. Bowles
3. Week 3: September 6, 2011: View Movie: Antwone Fisher: Assignment 2 Due
Week 6: September 27, 2011
Assignment 1 Due: Ethical Dilemma
Class will complete the required readings and view the movie, Antwone Fisher.
Assignment2: Antwone Fisher ( Due Week 6: September 27, 2011) Based on
your readings and viewing of the movie, Antwone Fisher, address the following
questions from the movie.
Each question is worth 20 points for a total of 100 points.
1. What role did Davenport play in Antwone’s life other than his therapist? What
was the quality of the relationship between Davenport and Antwone? What
was Antwone’s contribution to treatment and what role did hope play?
2. What role do you think Davenport’s theoretical orientation plays in Antwone’s
progress? What role did Antwone’s girlfriend Cheryl play in his treatment and
his life?
3. What cultural/class issues are relevant to Antwone’s treatment/therapy? Is
the relationship between Antwone and Dr. Davenport cross-cultural? If so, in
what ways? How are cultural and or class differences addressed?
4. In what stage of change is Antwone at the start of treatment? When and to
which stage does he shift? To what do you attribute that change?
5. Is Davenport an ethical psychiatrist? Why or why not?
Required readings:
Walsh, Chapters 1, pp 1-16.
Tseng, W.S. & Streltzer, J. (2001). Culture & Psychotherapy. Chapter 17; pp. 265-278.
Washington DC: American Psychiatric Press.
*Berzoff, J., Flanagan, Laura M., and Hertz, P. (2008). Inside Out and Outside In (2nd Ed.
New York: Jason Aronson. Chapter 14 by Lourdes Mattei, “Coloring
Development: Race and Culture in Psychodynamic Theories”, pp. 245-271.
Optional readings:
Harper, K.V. & Lantz, J. (1996). Cross-cultural Practice. Chicago: Lyceum. (Chapter 1:
Cross-cultural curative factors.)
4. Weeks 4 & 5: September 13 & 20, 2011
Week 4: September 13, 2011:
Psychodynamic Theories I: Ego Psychology
Ego Psychology and Ego Functions
Common Mechanisms of Defense
Evaluation of Defenses
Week 5: September 20, 2011;
The Autonomous Ego Functions
Case: The Girl in the Window
Specific Ego Intervention Strategies
Ego Psychology and Principles for Terminating with Clients
Ego Psychology and Social Justice Issues
Ego Psychology and Spirituality
Role Plays: The Post Traumatic Stress Survivor, In Walsh, pp. 53-55
Psychosocial Ego Development Theory of Erik Erikson;
Role Play Using Ego Psychology Strategies. CASE: : The Post Traumatic Stress
Survivor, pp. 53-55 taken from Direct Social Work Practice by Joseph Walsh.
You are to read the entire case. The Role Play will be based on the 4th Paragraph of
the Case found on page 53, which begins: “After their fourth session, Heidi’s
depression and anxiety increased.” Four ego psychology strategies are listed below
and there will be four (4) role plays with 8 students. For each Role Play, one student
will be the SW and the second student the client. The Role Plays will demonstrate one
of the Ego Psychology Strategies listed below.
1. With the information you know, do a beginning interview that
demonstrates sustainment or establishing a relationship with Heidi.
2. Do an interview that demonstrates Exploration/Description/ Ventilation
and Person Situation Reflection.
3. Do an interview that demonstrates Partializing (Structuring) and
Education.
4. Do an interview that demonstrates Developmental Reflection
Required readings:
Walsh, Chapter 3 – Ego Psychology, pp. 32 - 61
Berzoff, “Inside Out, Outside In: An Introduction, pp. 1-15 and Chapter 4, “Ego
Psychology”, pp. 63-97.
Berzoff, Chapter 5, “Psychosocial Ego Development: The Theory of Erik Erikson, pp. 99
– 120.
Optional readings:
Malick, M.D. (1991). Re-assessing assessment in clinical social work practice. Smith
College Studies in Social Work, 62, 3-17.
6. Week 6: September 27, 2011
Assignment 2 Due: Antwone Fisher
Psychodynamic Theories II: Object Relations Theory
Object Relations Theory
Early Nurturing and Attachment Theory
Two Object Relations Theorists: Donald Winnicott and Margaret Mahler
Margaret Mahler’s Separation/Individuation Phases
Assessment and Intervention
Required readings:
Walsh, Chapter 4 – “Psychodynamic Theories II: Object Relations Theory”, pp. 62 –
89.
Berzoff, Chapter 6, “Object Relations Theory” by Laura Melano Flanagan, pp. 121160.
Berzoff, Chapter 8, “Attachment Theory” by Robert Shilkret and Cynthia Shilkret, pp.
189-204.
Bowles, Dorcas (1983). Ethnicity and Race: Critical Concepts in Social Work.
Washington, D.C. NASW Press. “ Development of an Ethnic Sense of Self” using
Object Relations Theory (On Reserve in Library)
Optional reading:
Borden, W. (2009). Object relations psychology. In Roberts & Greene (Eds.) Social
Worker’s Desk Reference, pp. 305-310. Oxford Press. (Available to copy from
Dr. Bowles.)
7. Week 7: October 4, 2011
Psychodynamic Object Relations Theory and Gender
Object Relations and Social Justice
Object Relations and Spirituality and Principles for Terminating with Clients
Diversity and Cultural Factors: Issues faced by Majority Workers with Clients of
Color and by Workers of Color working with Clients of Color (Class Discussion)
Case Discussion - The Wild Child (Walsh, pp. 79 – 82)
Required readings:
Berzoff, Chapter 10, “Psychodynamic Theory and Gender”, pp. 229-244.
Berzoff, Chapter 11, “Coloring Development: Race and Culture in Psychodynamic
Theory” by Lourdes Mattei, pp. 245 – 270.
Optional readings:
Chapter 5 – Family Emotional Systems Theory
Dalzell, Heidi J. (2001). Insight at any age: Psychodynamic treatment of older adults.
Psychoanalysis & Psychotherapy Vol 18(2), 241-260. (Available to copy from
Dr. Bowles.)
Messer, S.B. (2002). A psychodynamic perspective on resistance in psychotherapy:
Vive la resistance! Journal of Clinical Psychology, 58(2), 157-163.
8. Week 8: October 11, 2011
Personality Disorders (also known as Character Disorders) with a Special
Emphasis on Borderline and Narcissistic Personalities
Meaning of Term Personality Disorder or Character Disorder
Borderline Personality Disorders
Borderline Personality in Context of Person’s Object Relations, Ego Functions and
Sense of Self
Review of Object Relations Chart
Case: Mary Ann F.: A Borderline Mother and her New Born
Narcissistic Personality Disorder
Narcissistic Personality in Context of Person’s Object Relations, Ego Functions and
Sense of Self
Required Reading:
Berzoff, Flanagan and Hertz, Inside Out and Outside In, “Personality Disorders with a
Special Emphasis on Borderline and Narcissistic Personalities. Chapter 14, pp.
311-354.
Walsh, pp. The Nature of Problems and definition of “Splitting”, pp. 74-75.
Borden, W. (2009). Interventions with Borderline Personality Disorder. In Roberts &
Greene (Eds.) Social Worker’s Desk Reference, pp. 305-310. Oxford Press, pp.
742 – 751. (Available to copy from Dr. Bowles.)
9.Week 9: October 18, 2011
Assignment 3: Psychodynamic Application Paper Due: Case of Susan: Week 9,
October 18, 2011
Narcissistic Personality Disorder Continued
Behavioral Theory
Intervention Techniques Using Behavioral Theory
Social Justice Using Behavioral Theory
Spirituality Using Behavioral Theory
Required readings:
Walsh, Chapter 6 – Behavioral Theory
10.Week 10: October 25, 2011
Behavioral Theory Continued to include
Spirituality
Social Justice
DVD: Cognitive Behavioral Therapy with John Krumboltz
Required readings:
Borden, W. (2009). Cognitive-Behavioral Theory. In Roberts & Greene (Eds.) Social
Worker’s Desk Reference, pp. 305-310. Oxford Press. (Available to copy from
Dr. Bowles.)
Borden, W. (2009). A Behavioral Approach to Social Work Treatment. In Roberts &
Greene (Eds.) Social Worker’s Desk Reference, pp. 288 - 294. Oxford Press.
(Available to copy from Dr. Bowles.)
Rokke, P.D. & Rehm, L.P. (2001). Self-management techniques. In K. Dobson (Ed.),
Handbook of Cognitive-Behavioral Therapies, pp. 242 - 247. New York: Guilford
Press.
11. Week 11: November 1, 2011
Cognitive Theory
Assessment
Intervention
Cognitive Theory and Social Justice
Cognitive Theory and Spirituality
DVD: Depression: A Cognitive Therapy Approach with Arthur Freeman, Ed.D
Required readings:
Walsh, Chapter 7 – Cognitive Theory
Borden, W. (2009). Cognitive Restructuring Techniques. In Roberts & Greene (Eds.)
Social Worker’s Desk Reference, pp. 588-594. Oxford Press. (Available to copy
from Dr. Bowles.)
Optional readings:
Beck, J.S. (1995). Cognitive therapy: basics and beyond. New York: Guilford. (On
Reserve)
Interpersonal Therapy and Structural Family Theory
12. Week 12: November 8, 2011
Interpersonal Therapy and Structural Family Theory
Interpersonal Therapy
Interpersonal Therapy
Elements of Psychodynamic Theory
Elements of Cognitive and Behavioral Theory
Assessment
Intervention
Interpersonal Therapy and Social Justice
Interpersonal Therapy and Spirituality
Case: The Rose from Spanish Harlem – Class Discussion (Walsh, pp. 187 -192
Structural Family Theory
Major Concepts and Other Concepts
The Nature of Problems and Change
Assessment
Interventions Ending Structural Family Therapy
Structural Family Theory and Social Justice
Structural Family Theory and Spirituality
DVD: Structural Family Therapy with Harry Aponte, LCSW
Required Readings:
Walsh, Chapter 8 – “Interpersonal Therapy”, pp. 177 -198.
Walsh, chapter 9 – “Structural Family Theory”, pp. 199 – 229.
13. Week 13: November 15, 2011
Structural Family Theory Contd.
Narrative Therapy
Narrative Theory Defined
Major Concepts of Narrative Theory
Assessment using Narrative Theory
Interventions Using Narrative Theory
Terminations and Narrative Therapy
Narrative Therapy and Spirituality
Narrative Therapy and Social Justice
Case: Bag Lady – Walsh, pp. 289-291 and Case Examples from the Class
Required readings:
Walsh, Chapter 12 – Narrative Theory
Optional reading:
Goncalves, O.F., Machado, P. P. P. Korman, Y., Angus, L. (2002). Assessing
psychopathology: A narrative approach. In: L.E. Beutler & M.L. Malik (Eds.),
pp. 149-176. Rethinking the DSM: A psychological perspective. Washington DC:
APA.
*Borden, W. (2009). Narrative Therapy. In Roberts & Greene (Eds.) Social Worker’s
Desk Reference, pp.273-276. Oxford Press. (Available to copy from Dr. Bowles.)
14. Week 14: November 22, 2011
Assignment 4 Due: Cognitive Behavioral, Psychodynamic or Interpersonal
Theory- Practice Application Paper Due
Case of Alice (Select one theoretical Perspective)
202
Narrative Therapy Cont’d
(Fall Break – No Classes – November 23 – 27, 2011)
15. Week 15 Wednesday November 29, 2011
Time Limited Dynamic Psychotherapy
Definition of Time Limited Dynamic Psychotherapy
Five Essential Assumptions of TLDP
Two Goals of TLDP
Five Major Criteria used in Determining Clients’ ability to benefit from TLDP
How the SW obtains data that will be used to show that there is a Maladaptive
Pattern
DVD: Time Limited Dynamic Psychotherapy by Psychotherapy Net. Dr. Hannah
Levenson, Therapist. Psychotherapy. Net
Questions for Class Discussion following a Review of the DVD
1. Did Mr. Johnson, the client, demonstrate the five essential assumptions of
Time Limited Dynamic Psychotherapy?
2. Why does Dr. Levenson push Mr. Johnson so hard to talk about his feelings in
spite of his insistence that he is unable to do so?
3.
When Dr. Levenson interprets Mr. Johnson’s disclosure of his feelings of
disappointment, do you agree with her linking the feelings with
abandonment?
4. What was most helpful to you as a SW about the TLDP model? What
perspectives did you find helpful and might use in your own work?
5. What do you think you would have done differently than Dr. Levenson, the
therapist, in the video? Be specific in what different approaches and
techniques you might have applied and state why you would use these
different approaches.
203
Required readings:
Levenson, Hanna, “Time Limited Dynamic Psychotherapy”, from The Art and Science
of Brief Psychotherapies, pp. 157 -184. On Reserve in Library
Walsh, Chapter 13 – Crisis Theory & Intervention
Eaton, Y.M. & Roberts, A.R. (2004). Frontline crisis intervention. In Roberts & Greene
(Eds.) Social Worker’s Desk Reference, pp. 89-96. Oxford Press. (On Reserve)
16. Week 16: December 6, 2011: Final Class (Final Exam Week: December 6 12, 2011
Motivational Interviewing
Definition of Motivational Interviewing
Transtheoretical Stages of Change (TSOC) Model – A Major influence of
Motivational Interviewing
Clinical Perspective in Motivational Interviewing
The Social Worker Client Relationship and Assessment in Motivational Interviewing
Intervention in Motivational Interviewing
Specific Techniques used by the Social Worker in Motivational Interviewing
Developing a Change Plan Technique that Supports Self –Efficacy
Motivational Interviewing and Spirituality
Motivational Interviewing and Social Justice
DVD: Client Mike by William Miller. developer of Motivational Interviewing,
Psychotherapy Net Video Collection – Enhance Your Training Program
Termination with Clients
Professor’s Closing Comments
Required readings:
Walsh, Chapters 12 – Motivational Interviewing, pp. 253-272
Walsh, J. (2003). Endings in Clinical Practice. Chapters 2 & 3; pp. 22-56. Chicago:
Lyceum Books. (Available on WebCT)
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O’Leary Tevyaw, T. & Monti, P.M. (2004). Motivational enhancement and other brief
interventions for adolescent substance abuse. Addiction, 99, 63-75,
Supplement 2.
Berzoff, Chapter 18, pp. 443-446.
Optional reading:
Elks, M.A., & Kirkhart, K.E. (1993). Evaluating effectiveness from the practitioner
perspective. Social Work, 38(5), 554-563.
Mercier, C., Landry, M., Corbiere, M. & Pereault, M. (2004). Measuring clients’
perception as outcome measurement. In Roberts & Yaeger (Eds.), EvidenceBased Practice Manual, pp. 904-909. Oxford Press.
PLEASE NOTE: You will be doing one assignment on an ethical issue, one assignment
based on the film, Antwone Fisher, and 2 application of practice papers. Each paper
should be between 10-15 pages long, double-spaced. If the papers can be completed
in fewer than 15 pages that is fine. If the paper is a page or two longer than 15 pages
that is also fine. Remember: More does not mean better. They are due at the
beginning of each class as follows:
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Case of Susan
Family Service Agency
Case Study: Susan
Identifying Information
Susan is a 40 year old Caucasian woman. She identifies herself as lesbian; has never
been married and has no children of her own. She has been unemployed for roughly
6 years, although she did at one time have a “high paying job” of about $45,000 a year
as a locksmith. In addition to her salary, Susan often received good tips for her work
as a locksmith. Susan currently collects Social Security Disability Insurance (SSDI) as
a result of severe back problems she has had since childhood, based in part on
beatings she received at the hands of her Father and beatings from her lesbian lover,
Tina and Tina’s boyfriends. Susan was in a 12 year lesbian relationship with Tina
who had two daughters, J and T. The two daughters were by two of Tina’s former
boyfriends. Susan does not attend church regularly, but when she does, she attends a
Unitarian Church.
Description of Client
Susan presents as a very thin woman who looks older than her 40 years. Her face
and neck are scarred with slashes and discolorations and her cheeks are drawn in
from a recent drastic loss in weight. She walks slowly and with a cane. She has eight
teeth remaining and reports intense pain in her face because these teeth are
decaying. Susan’s teeth were basically knocked out during fights with Tina and
Tina’s boyfriends. She is in need of glasses and her eyes squint. She often uses her
hands to cover her mouth as a way of not letting others see that most of her teeth are
missing.
Susan speaks in a slow pace, with very little emotional inflection and often stutters
when discussing painful memories experienced from her childhood in relationship to
physical abuse by her father, sexual abuse by her siblings, and adult life with her
lover, Tina, and Tina’s boyfriends who also severely physically abused her. Susan
often uses humor to describe some of her more painful memories. She graduated
high school, but reports she can read only at about a 6th grade level. She loves
working with her hands and took courses that led her to becoming a locksmith which
she was good at until she was forced to give up being a locksmith because of severe
back injuries. At the beginning of TX, Susan’s affect was somewhat labile, changing
from angry to defensive, to sad, hopeless, and somewhat apologetic. During the
initial interviews, Susan described her recent loss of a 12 year relationship with Tina,
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a female lesbian partner, and her two female children, J and T, that Susan and Tina,
raised together. Early meetings with the SW focused on Tina’s leaving/abandoning
Susan and taking the two girls, J and T, that Susan had come to love and become
attached to, with her. Susan felt she was a parent to the two girls and that she could
see sadness in the faces of the two girls when Tina left with them. Susan experienced
feeling sad, depressed and “out of sorts” when Tina took the two girls, J and T and
left. In later meetings with the SW, Susan would become unable to think of anything
else except her memories of childhood physical and sexual abuse by her father, two
brothers and older sister.
Susan lives in a private single room of a large boarding house that she rents. There
are 4 other female residents in the boarding house where the 4 tenants share a
bathroom and a kitchen. Susan has had this living arrangement since the breakup
with her girlfriend, Tina. Near the end of TX, Tina moved into a one room apartment
where she currently resides.
Referral
Susan was a “walk-in” client to the Family Service Agency which was about two
blocks from the boarding house where she lived. One of the other female boarders
had indicated that she had previously received help from the agency, and Susan
decided to seek help on her own. Susan told the intake SW that she would “really
appreciate someone to talk to because things are falling apart for me, and I cannot
figure things out.” The Intake SW did a brief intake interview and Susan was
assigned to a 2nd year SW student from a graduate school of social work. Meetings
were planned for once per week with the MSW intern.
Family History
Susan is the youngest of five children: two older brothers and two older sisters.
Susan was sexually molested for years by her two older brothers and by the older
sister. Susan had a fairly good relationship with the sister who was 2 years her
senior and next to her in age. Susan remembered that the sexual abuse happened to
her between the ages of 8 and 13. Susan stated that the two older brothers often
molested her individually and together as a team, and she does not feel that the
brothers knew that the oldest sister was also sexually molesting her. The oldest
sister was later hospitalized for psychiatric reasons, and later developed MS. In
addition to being molested by her siblings, Susan stated that a total of 11other men
had sexually abused her, some family members and others neighbors and friends of
the family. Susan’s father was an alcoholic and she reported being beaten by her
father as well as witnessing the Father severely physically abuse her mother. He (her
father) always beat the Mo. in the kitchen. The father gave the Mo. a skull fracture in
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the back of her head and Susan is certain that this blow led to the aneurism that
subsequently killed the Mo. Susan was age 13 when her Mo. died and has been on
her own pretty much since then.
Treatment Sessions
Susan was in a lesbian relationship for 12 years with a woman, Tina, ten years her
senior. Susan was age 28, and Tina age 38, when the lesbian relationship began. Tina
had two female children, J and T, by two different men, and the two children also
lived in the household. Susan experienced physical and emotional abuse in the
relationship with Tina. When Susan first talked about Tina, she alternated between
seeing her as evil and as a “good woman with a good heart.” Although Tina had left
Susan 9 months earlier when TX began, Susan felt responsible for the failed
relationship. Susan could not have children and came to develop positive feelings
toward the two female children, J and T, who were Tina’s children by different men
prior to Susan’s and Tina’s relationship. Also, when Susan met Tina, Susan was
working and making a fairly good salary, of approximately $45,000 per year, as a
locksmith. Tina was unemployed and was basically being taken care of sporadically
by the children’s fathers and other men with whom she had relationships. Susan
supported Tina and her two children and became very emotionally attached to the
two girls. As far as Susan knows, Tina was in relationships with males prior to their
becoming lovers, and she is Tina’s first lesbian relationship.
Tina was very physically abusive to Susan during the 12 year relationship, and Susan
initially blamed herself for Tina’s abuse of her. Susan stated: “It’s my fault for
bringing a straight woman out as a lesbian. Tina beat me and cheated on me and I let
her. It’s my fault. I came to love Tina and her two daughters and now I have no-one.
Tina is the only person who loved me other than my Mo., but my Mo. could not show
her love to me, because she was physically abused by my Fa. and was depressed all
the time.” Tina would punch Susan in the face, chest and stomach, and throw chairs,
vases and other large objects at her, some of which hit Susan in the face and on
various other parts of her body. Often the fights with Tina were about boyfriends that
Tina brought to the house. Tina had boyfriends throughout the relationship with
Susan and the boyfriends also physically abused Susan. More than one of Tina’s
boyfriends physically beat and abused Susan. Tina would watch these fights and “egg
the boyfriends on” as they physically beat and abused Susan. Susan felt the beatings
from Tina and her boyfriends were her fault because she was bad and deserved the
beatings. Oftentimes, the fights with Tina’s boyfriends started when Susan would yell
at the boyfriends that Tina did not love them, but loved Susan.
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One of Tina’s boyfriends had held a gun to Susan’s head and Susan had said: “Go
ahead – put me out of my misery.” Another of Tina’s boyfriends, broke Susan’s cheek,
knocked three of her front teeth out, and smashed her glasses. Susan stated that she
has gotten hit in the head so much and tried to abuse herself so much with drugs that
she wonders if her brains aren’t fried. Susan stated that sometimes it feels like
there’s so much noise in her head, like a banging back and forth. She has headaches
all the time. She knows that the headaches are related to the abuse she received as a
child from her father and from fights with Tina and her boyfriends.
During Susan’s and Tina’s relationship, Susan rented an apartment that consisted of
two bedrooms; 2 baths with one bath connected to the large master bedroom and the
other bath off of the 2nd bedroom; a large living room; dining room; kitchen with a
large pantry; and a small Den which was used to watch TV. The apartment provided
a place where Tina and her girls could live. The girls shared one bedroom and bath
and Susan and Tina the master bedroom and bath. Susan was doing well health-wise,
until she began to experience severe beatings at the hand of Tina and Tina’s
boyfriends, which worsened a back problem she had from beatings she experienced
at the hand of her father. Susan’s back problems worsened and resulted in her not
being able to continue her work as a locksmith and having to receive Social Security
Disability Insurance (SSDI). Once Susan began receiving SSDI, she lost the apartment
because it was too expensive; Tina and the girls left; and Susan was only able to
afford a room in a boarding house where she currently lives.
Tina would occasionally bring the two girls, J and T, to visit Susan, often accompanied
by a new boyfriend. Tina was also able to get Susan to give her small sums of money
for the girls which Susan could not refuse because she had become attached to the
girls and wanted the best for them. Once Tina got the money from Susan, she would
leave. If Susan asked if the girls could stay with her for a while longer, Tina would
say No and snatch the kids and leave. Susan is sure the girls were confused as they
would often turn to look at Susan as though they wanted to stay, but Tina would rush
them out without Susan and the girls being able to say good-bye. Susan says that she
felt overwhelmed, was not able to sleep, was more overwhelmed than she had ever
been, and would be upset that if she did not do what Tina said, she would not be able
to see the girls. Susan felt she had lost everything - her job, her health, the
apartment, Tina, and the girls. Susan has no contact with members of her family who
live in another state. Susan felt she had no one and could not live without Tina and
the girls.
Part of TX focused on helping Susan to see that she is separate from Tina and the
girls and that she can have a life separate from them. During these sessions, Susan
would cry incessantly because she felt her life was over without Tina and the girls.
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Gradually, with the SW’s help, Susan began to see some of her strengths and that her
relationship with Tina was “exploitative”; that Tina was “manipulative” and that she
could live without Tina and the girls. It took several sessions for Susan to begin to
internalize that she had strengths and to begin to “feel whole” and worthwhile as a
person without Tina and the girls.
During this time, as Susan was beginning to feel comfort with herself, she would
occasionally express feeling empty without Tina and the girls in her life and she
began to drink again. Susan stated that on one occasion, she drank a fifth of tequila
to make the pain inside her go away. She does not want to drink because she has
been through “drinking binges” before. In the past, Susan would drink heavily,
especially after beatings from Tina and/or Tina’s boyfriends. The last time Susan
drank tequila, following a beating by one of Tina’s boyfriends, she spent 3 days
praying to the porcelain God she had in her apartment. Susan stated that she feels
tired. So tired, she just wants to crawl in her shell. She wants to be alone; she’s tired;
wants to go to her room and lay there. She thinks about her Mom; listens to the cars
go by; does not think of anything; does not want to go out to get food or groceries.
She only wants to walk around in her room by herself. Susan expressed that at these
time, being alone allows “me to think about and process what we talk about during
our sessions; this makes me feel stronger and allows me to think of my past and
where I am in my life without Tina and the girls. I hold on to these thoughts and it
gets me through these rough spots until I can speak with you again.” The SW
commented that what Susan has just described represents growth on her part and
that given her past, it takes time for healing to occur. Susan has done a lot of hard
work to get to this place and the SW expressed that she is proud of the progress Tina
has made. Tina was teary eyed and said: “I could not be at this place were it not for
our time together. Thanks for all you have done to help me.” The SW explained to
Tina that Tina had done the work and she should feel proud of what she has
achieved. Tina thanked the SW for caring about and being there for her. “I would
probably be dead if I did not have you”, Tina stated.
The Family Service Agency used a psychiatrist for consultation services and the SW
referred Susan to the psychiatrist for a psychiatric exam for her depression and
“feelings of emptiness” and she was placed on meds for her depression. Susan stated
the meds have helped her feel better and less depressed. As well, Tina had not
visited Susan for several months and Susan was doing better; feeling stronger. Susan
had been saving money and living frugally with the goal of moving to a small
apartment. She was able to find a small apartment she could afford, was able to pay
the required deposit, and was making plans to move.
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Then, several weeks later on a Saturday, Tina brought Susan food but did not bring
the girls. Susan had not seen Tina for several months and was feeling that she was
getting herself together and ready to move on with her life. Susan and Tina ate some
of the food Tina brought, and talked about things in general and the discussion went
well. Susan told Tina that she had put a deposit on an apartment and planned to
move soon.
On the next day, Sunday, Tina brought the girls to see Susan. Tina knew from talking
with Susan on Saturday, that Susan planned to move to an apartment. On that Sunday
when Tina brought the girls to see Susan, Tina talked about the possibility of she and
Susan getting back together and trying to make the relationship work. Susan was
quite surprised and explained to the SW in her next session, that she did not trust
Tina so she just took the information in without commenting. Tina still has her
boyfriends and Susan feels that Tina wants another “free ride”, but Susan is not
prepared to get involved with Tina again. Susan was finally able to see and realize
that Tina had “used me so she and her two daughters could live rent free” in Susan’s
apartment and have food and bills paid by Susan. The SW could see that Susan’s
understanding and insight, based on their work together and the gains made in TX,
were remarkable.
Susan was finally able to see that her relationship with Tina was exploitative, abusive
and unhealthy.
Susan explained to the SW that based on the work she had done in TX with the SW,
she is feeling better, feeling stronger and does not want to return to the place she
was at earlier. Susan stated that she knows that Tina is not good for her and it has
taken some time for her to work out her feelings regarding Tina and the abuse she
experienced with her and the abuse she experienced at the hands of her father. She
does not want to and does not deserve to get hurt again. Susan repeated what the SW
had told her on several occasions: “As you said, I can be my own person and am
worthy and deserving of a better life.”
With the SW’s help, Susan was able to explain to Tina that it had taken her a long
time to work through the abuse she had experienced with Tina and her boyfriends.
Susan stated that she loved J and T and wanted the best for them, but felt it was in
everyone’s best interest that she and Tina not get back together. Susan stated that
she would miss the girls, J. and T., but needed to get on with her life and Tina and the
girls needed to get on with their lives. Tina was angry and wanted to start a fight, but
Susan held her ground and said she needed to move on and did not want to repeat
the pain of the past.
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Tina tried to get Susan to give her the address where she was moving, but Susan said
she could not give her the address. They needed to say good bye. Tina tried to turn
the cards and say that she did not want a relationship with Susan and never wanted
to see Susan again. Also, she would make sure Susan never saw the girls. J and T.,
again. Susan attempted to give Tina a hug good bye and to tell the girls good bye and
give them a hug, but Tina pulled away and took the girls’ hands and left without any
goodbyes. Susan felt sad that things ended this way, but felt she had to protect
herself and would not allow Tina to “manipulate” her further. (The word manipulate
had been used by the SW to explain Tina’s relationship with Susan.)
Susan moved to her new apartment. It is a small one bedroom apartment, and she
has spent time fixing it up and is enjoying having time to herself and doing things she
enjoys. She attended church last week and re-connected with a woman, Judy, she
had known earlier when she attended church. She and the woman have had coffee
together and gone to a few movies. These were things Susan once enjoyed but had
not done when she was living with Tina. Susan feels good that she is doing things she
enjoys. The woman is divorced and “straight” and Susan enjoys her company. Susan
has stated that this is the first time she has ever had a “real friend” that she can talk
and share her ideas with. Susan has explained to Judy that she is a lesbian and the
woman has expressed that while that is not her lifestyle, she respects Susan and her
lifestyle. Susan stated that Judy is okay with Susan being a lesbian and Judy being
straight and respected Susan for being who she is and Susan is fine with Judy being
straight and her own person. Judy has had several other church members to her
house for special occasions and Susan has gone and has had a good time. Susan feels
she wants an intimate female relationship, but feels that until she finds a “good,
healthy” relationship that is not “exploitative and manipulative”, she is fine.
The student SW left the agency to return to school and Susan was quite sad and
depressed when she left. The student SW transferred Susan to another worker in the
agency and Susan continued to see the other SW. The new SW explained that it was
natural for Susan to feel sad at the loss of the student SW. The two of them had
worked hard together and it was natural that Susan would miss her. Gradually,
Susan’s sadness lessened as she got to know the new SW and felt comfortable talking
with her.
After several months, the new SW expressed to Susan that she felt Susan was at a
place where she no longer needed to see the SW. Susan was hesitant at the idea
initially but agreed to a plan where Susan would continue to be seen weekly for
another month after which Susan would be scheduled to come every two weeks.
Prior to the change to being seen once every two weeks, the SW and Susan talked
about Susan’s feelings about the change and what Susan might feel and that they
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would monitor Susan feelings to determine if the change in schedule was okay for
Susan. This same process was followed for scheduled appointments on a once per
month basis. Susan did fine with the changes and the SW introduced the idea that
Susan was ready to be on her own with the understanding that Susan could call the
agency should she have other issues she wanted to address. Susan accepted this final
arrangement and acknowledged that the gradual reduction in visits had been good
for her and had allowed her to prepare for being on her own. Susan expressed that
she is indebted to the student SW and the current SW for “saving my life and helping
me feel whole and complete”. Susan has been on her own now for some time. She
has only called the new SW on one occasion when she was feeling sad and needed to
process her feelings. The SW and Susan were able to talk on the phone and Susan felt
this was adequate. Susan knows that the agency is there for her should she need to
contact them. Susan has made no further calls to the agency.
ASSIGNMENT 3: Due: Week 9: October 18, 2011
Psychodynamic Application of Theory: Case of Susan
Application of Psychodynamic Theories (Object Relations and Ego Psychology)
to Case of Susan.
Answer each question. Be sure to number and state the question before each
response so that I know the answer that corresponds with the question.
Questions:
1.
Based on the information given in the case-study, (a) what are Susan’s
strengths? Where would you locate Susan developmentally and why? (b)
provide the characteristics of the developmental stage with specific
information from the case study that support your choice; and (c) describe
treatment interventions used by the SW to support Susan in moving from the
stage you have selected to a different/higher stage. (20 points)
2. The relationship between Susan, Tina, and Tina’s boyfriends was quite
abusive. How do you explain Susan’s acceptance of the physical abuse from
Tina and Tina’s boyfriends. (20 points)
3. Based on lectures and readings, (a) assess Susan’s ego functioning (b) What
areas of ego functioning are working well? (c) What ego functions are not
working well? (c) What ego defenses is Susan using? Give specific examples.
(20 points)
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4. You are assigned as Susan’s social worker: (a) are there additional
interventions you would use? Why? Why not? (b) Would you refer Susan to
any other professional(s)? Identify professionals; explain reason for referral(s
(c) Explain how you would work with/coordinate with the other
professionals? ); (If you would not refer Susan to any other professional(s),
explain why. (20 points)
5. Explain the role of the student SW and give your assessment of the
relationship she formed with Susan and your thoughts about her TX of Susan.
Describe your thinking with regard to how the new SW handled the
termination with Susan and whether the handling was clinically appropriate
or clinically inappropriate. Explain your response. Be specific (20 points)
Case Study: Alice
Agency Setting: A Mental Health Agency
Identifying Information:
Alice is a 23 year old Caucasian, married female who is currently unemployed. She’s
been married for six years to her first and only husband, Joe. Alice was referred by
her primary care physician after no physical causes could be found for feelings of
chronic depression, fatigue, anxiety, migraine headaches and stomach aches during
the last three years. Approximately six months ago, Alice was fired from her job as a
cashier at a drug store. Since that time, she states that she spends most of her time
taking care of her pets: three dogs and two cats, and making crafts.
Alice is soft-spoken and describes herself as shy, dependent, and easy to feel hurt and
quick to feel guilty. In the past three weeks, she has been experiencing significant
levels of sadness, depression, anxiety and low self-esteem. She denies any suicidal
ideation. She states that she is very inhibited when it comes to talking about and
dealing with emotionally charged and disturbing issues and avoids such topics as
much as possible. Alice describes her husband as very supportive and hard-working.
She states that there are no difficulties in their marriage and she is very satisfied
being married to Joe.
Alice reports that she and her husband have tried
unsuccessfully since they have been married to have children.
Alice reports that when she was four years old, her mother, grandmother, and
grandfather all died in a car accident of which she was the only survivor. She claims
that she has no memories of the accident itself or of her biological mother. Alice
related the onset of her current symptoms to a time three years ago when she had
taken a trip to Texas to visit some of her relatives on her mother’s side of the family.
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At that time, she learned some of the details of the accident from her mother’s
relatives.
She stated that she had difficulty tolerating the return drive home,
especially on two lane roads. Since then, she has had dreams of the accident and has
been unable to drive a car herself.
Alice also reported that an elderly friend of hers, Sam, who has been a father figure to
her since she was a young girl, committed suicide about six months ago. Alice says
that since that time the dreams of the accident, as well as dreams of Sam, have been
more frequent.
FAMILY HISTORY:
Alice reported that her father was married once before his marriage to her mother
and twice after her mother’s death. Alice has a half-sister from her father’s first
marriage and two older siblings from his marriage to her mother. In addition, she
has two step-siblings from her father’s last two marriages. Alice says she had a great
deal of difficulty with her first step-mother when she was growing up. She described
her first step-mother as alcoholic and physically abusive of one of her sisters. This
step-mother also gave Alice a black eye once. Alice described her second stepmother as rejecting and not wanting to deal with Alice since this woman’s own
children were already gone. Alice reported that at age 16, she began running away
from home and staying out late at night and drinking and occasionally smoking
marijuana with friends. She says that this lasted for about one year and that she was
able to quit using alcohol and marijuana on her own. At age 17, Alice moved out of
the house and lived first with an aunt, then with her best friend and family, and
finally with her boyfriend (now her husband) and his family.
Alice stated that her primary reason for seeking social work intervention is to try to
remember and learn as much as she can about the accident that killed her mother
and grandparents and remember and learn as much as she can about her mother as a
person. She stated that her father had always discouraged her from talking about her
deceased mother when she was growing up. Alice wants to stop feeling depressed
and anxious and also start feeling better about herself.
She believes that
remembering and learning about her mother and the accident will help her do this.
In addition, she would like to get to the point where she is able to work and drive a
car again.
Application of Cognitive Behavioral or Psychodynamic Theory: Case of Alice
Due Week 14, November 22, 2011
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You are the social worker assigned to work one-on-one with Alice, the young woman
in the assigned case at the Mental Health Agency. You can select either the Cognitive
Behavioral theoretical perspective, the Interpersonal theoretical Perspective or the
Psychodynamic theoretical perspective as your frame of reference in working with
Alice. Please state your choice of theories first and briefly justify your choice as it
relates to the case. You are to choose only one theoretical perspective, even if in real
practice, you would choose to use parts of both theories.
Answer each question. Be sure to number and state the question before each
response so that I know the answer that corresponds with the question.
Questions:
State your theoretical perspective. (0 points)
Justify or state why you have chosen a particular theoretical perspective for your
work with Alice. (0 points)
1. Provide an understanding of Alice’s issues that is congruent with your chosen
theoretical perspective to include: (a.) a list of Alice’s strengths;(b) a
description of the problem(s) as it would be explained by your practice
theory; and (c) potential reasons for the problematic behavior(s) as explained
by your theory. (20 points)
2. Based on the information you have provided to Question No. 1, provide: (1) a
treatment plan including at a minimum two (2) treatment goals that are
congruent with Alice’s strengths and the theory you selected; and (2) the
approximate length of time you will need to achieve the goals selected and
why. (20 points)
3. Describe at least two interventions you might use in this case based on the
theory you selected and Alice’s strengths. Discuss how the interventions
relate to the treatment goals and how they would be implemented. (15
points)
4. Would your conceptualization and/or intervention be different if Alice were
described as a Mexican-American woman? Why or why not. If yes, describe
the differences. (20 points)
5. Describe two ways in which you would evaluate Alice’s progress. What would
you measure? How and when would you measure it? (15 points)
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6. What do you anticipate would be Alice’s response to termination and how
would you handle the termination including how and when you would inform
Alice of the termination. (10 points)
Glossary of Concepts
Psychodynamic Theory: Object Relations
Dorcas D. Bowles, Professor
Consolidation of Individuality and Emotional Constancy
The fourth sub-phase of separation individuation, which begins toward the end of
the second year is open-ended. During this period, a degree of object constancy is
achieved, and the separation of self and object representation is sufficiently
established. Mother is clearly perceived as a separate person in the outside world,
and at the same time has an existence in the internal representational world of the
child.
Emotional Refueling
During the practicing and rapprochement sub-phases, the infant moves away from
the mother, but when s/he becomes fatigued or depleted of energy, s/he seeks to reestablish bodily contact with her. This “refueling” perks the toddler up and restores
his/her previous momentum to practice and explore.
Mutual Cueing
A circular process of interaction established very early between mother and infant by
which they “empathically” read each other’s signs and signals and react to each other.
For example, the mother learns the meanings of the baby’s different cries and
movements: the baby learns to anticipate the mother’s ministrations: s/he also
learns soon which cues the mother (unconsciously) picks up and which she does not.
No mother perfectly responds to a baby’s cues, but serious mismatching of cues is an
obstacle in the path of smooth development.
Shadowing and Darting Away
During the rapprochement sub-phase, the child, at times, follows his/her mother’s
every move (“shadows” her); s/he cannot let the mother out of sight or out of his/her
vicinity. At times, we observe the opposite behavior, the child darts away, and waits
for and expects the mother to swoop him/her up in the mother’s arms and thus for
brief moments undo the “separateness”.
217
Ambivalence
Ambivalence can occur only when there is representation of a single, whole person.
Separation/Individuation has to have occurred at least in its beginning stage. The
person can tolerate mixed feelings occurring at the same time; can tolerate good and
bad feelings being present in the same person.
218
Glossary of Concepts Psychodynamic
Theory: Object Relations Dorcas D.
Bowles, Professor
Consolidation of Individuality and Emotional Constancy
The fourth sub-phase of separation individuation, which begins toward the end of
the second year is open-ended. During this period, a degree of object constancy is
achieved, and the separation of self and object representation is sufficiently
established. Mother is clearly perceived as a separate person in the outside world,
and at the same time has an existence in the internal representational world of the
child.
Emotional Refueling
During the practicing and rapprochement sub-phases, the infant moves away from
the mother, but when s/he becomes fatigued or depleted of energy, s/he seeks to reestablish bodily contact with her. This “refueling” perks the toddler up and restores
his/her previous momentum to practice and explore.
Mutual Cueing
A circular process of interaction established very early between mother and infant by
which they “empathically” read each other’s signs and signals and react to each other.
For example, the mother learns the meanings of the baby’s different cries and
movements: the baby learns to anticipate the mother’s ministrations: s/he also
learns soon which cues the mother (unconsciously) picks up and which she does not.
No mother perfectly responds to a baby’s cues, but serious mismatching of cues is an
obstacle in the path of smooth development.
Shadowing and Darting Away
During the rapprochement sub-phase, the child, at times, follows his/her mother’s
every move (“shadows” her); s/he cannot let the mother out of sight or out of his/her
vicinity. At times, we observe the opposite behavior, the child darts away, and waits
for and expects the mother to swoop him/her up in the mother’s arms and thus for
brief moments undo the “separateness”.
Ambivalence
Ambivalence can occur only when there is representation of a single, whole person.
Separation/Individuation has to have occurred at least in its beginning stage. The
person can tolerate mixed feelings occurring at the same time; can tolerate good and
bad feelings being present in the same person.
219
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223
Revised Syllabus
224
MASTER OF SOCIAL WORK PROGRAM
SW 8702: Advanced Clinical Practice I: Working With Individuals
Professor:
Dorcas D. Bowles
Meeting Time:
TBA
Semester Credits:
3 hrs.
Email Address:
dbowles3@kennesaw.edu or
dorcasbowles@bellsouth.net
Phone Number:
678-797-2453
Office:
Room 3323 Prillaman Hall
Office Hours:
Mondays: 10:00am – 12 Noon and 1:00pm –
3:00pm Tuesdays 9:00am-1:00pm or by
appointment
COURSE DESCRIPTION
This Advanced Clinical Practice I: Working with Individuals course builds upon basic
skills covered in the first year foundation practice, human behavior and the social
environment, policy, research courses and field experiences. The course will assist
students with specializations in Child and Family Services, Mental Health and the
subspecialty, Substance Abuse, in their assessment and intervention with individuals.
COURSE OVERVIEW
Social Work 8702: Advanced Clinical Practice I: Working with Individuals will begin
with a discussion of the meaning of theory and the history of clinical social work. The
course will then cover the major clinical practice theories that social workers
225
commonly use in their assessment, planning, and intervention with individuals in
either of the two specializations- Children and Family Services or Mental Health and
the subspecialty, Substance Abuse. The practice theories covered include:
psychodynamic theories, including object relations and ego psychology; behavioral;
cognitive; interpersonal; structural family; narrative; time limited dynamic; and
motivational.
Additionally, there will be a discussion of personality disorders, also known as
character disorders, with a special emphasis on borderline and narcissistic
personalities. Spirituality and social justice issues, as defined by each of these
theories, will be infused as the various theories are discussed. The course is designed
to increase knowledge and understanding essential for effective therapeutic
interventions in psychological and behavioral disorders. Other topics will include:
ethics and values, the importance of the therapeutic relationship, diversity and
cultural factors, and the issues involved in terminating with clients. Formulation of
intervention strategies will employ multiple research techniques based on the
theories addressed. Assessment of intervention effectiveness is central to this course.
Prerequisites: All first year foundation courses including first year field internship.
Required Textbooks
Walsh, J. (2006). Theories for Direct Social Work Practice. Belmont, CA: Brooks/Cole.
Berzoff, J., Flanagan, Laura M., and Hertz, P. (2008). Inside Out and Outside In (2nd Ed.
New York: Jason Aronson.
Handouts: Handouts and additional readings will be distributed throughout the
term and/or placed on reserve in the library. Students who are absent from a
particular class are responsible for obtaining the handouts and additional readings
from the instructor.
COURSE RATIONALE RELATIVE TO THE MISSION OF THE MSW PROGRAM
The Master of Social Work Program at Kennesaw State University was established to
address increasing problems in the following specialization areas: Children and
Family Services and Mental Health Services including a subspecialty in Substance
Abuse. The Department is committed to making a positive difference in the
community in these areas. SW 8702 is related to and consistent with the mission of
the Masters of Social Work.
Course Objectives
226
Upon completion of the course, the student in specializations Children and Family
Services, Mental Health Services and the subspecialty Substance Abuse will be able
to:
SW 8702: Advanced Clinical Practice I: Working with Individuals
Knowledge Objectives: Upon Completion of this course students will:
1. Demonstrate knowledge and understanding of various theories and models
utilized in the clinical treatment of individuals and how to differentially apply
them to diverse populations; EP 2.1.3
2. Demonstrate knowledge and understanding of the importance of diversity in
one’s work with clients; EP 2.1.4
3. Demonstrate knowledge and understanding of how oppression and
discrimination impact clients; EP 2.1.5
4. Demonstrate knowledge of culturally responsive relationships; EP 2.1.10a
Engagement
5. Demonstrate knowledge and understanding of the bio-psychosocial-spiritual
factors that influence clinical interventions; EP 2.1.10b Assessment
6.
Demonstrate a theoretically informed knowledge base to ensure effective
practice interventions with individuals; EP 2.1.10c Intervention
7. Demonstrate knowledge that will allow for the evaluation of one’s work with
clients. EP 2.1.10d
Skills Objectives
1. Demonstrate solid professional identity as a social worker; EP 2.1.1
2. Demonstrate ability to apply ethical decision making skills to specific issues as
they relate to clients served while recognizing and managing one’s personal
biases; EP 2.1.2
3. Demonstrate ability to assess the strengths and weaknesses of a range of
theories and differentially apply them to diverse client situations; EP 2.1.3
4. Demonstrate ability to communicate professional judgments and collaborate
with professionals from various disciplines in coordinating treatment
interventions in one’s work with clients from diverse backgrounds; EP 2.1.3
227
5. Demonstrate ability to differentially apply theories of human behavior and the
social environment to guide one’s clinical assessments, interventions and
terminations with clients; EP 2.1.7
6. Demonstrate ability to engage, assess, intervene, and evaluate individuals
from diverse backgrounds based on an understanding of their strengths and
resources; EP 2.1.10 a-d
Values Objectives
1. Appreciate and understand one’s personal and professional values, ethical
principles, and legal mandates pertinent to one’s clinical practice with
individuals; EP 2.1.2
2. Engage in self-reflection in the interest of clients served from diverse
backgrounds; EP 2.1.3
3. Recognize client strengths, coping strategies, vulnerabilities and spirituality in
making assessments and interventions EP 2.1.10 b, c
Practice Behaviors that correspond with the course objectives and the ten
advanced competencies
1. Readily identify as a social work professional EP 2.1.1
2. Demonstrate professional use of self with client/s; EP 2.1.1
3. Apply ethical decision-making skills to issues specific to clinical social work
EP 2.1.2
4. Engage in reflective practice EP 2.1.3
5. Identify and articulate clients’ strengths and vulnerabilities EP 2.1.3
6. Research and apply knowledge of diverse populations to enhance client
well-being EP 2.1.4
7. Use knowledge of the effects of oppression, discrimination, and historical
trauma on client and client systems to guide treatment planning and
intervention EP 2.1.5
8. Synthesize and differentially apply theories of human behavior and social
environment to guide clinical practice EP 2.1.7
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9. Assess the quality of clients’ interactions within their social contexts EP
2.1.9
10. Develop a culturally responsive therapeutic relationship EP 2.1.10a
Engagement
11. Use multi-dimensional bio-psychosocial spiritual assessment tools EP
2.1.10b Assessment
12. Collaborate with other professionals to coordinate treatment interventions
EP 2.1.10c
13. Use clinical evaluation of the process and/or outcomes to develop best
practice interventions for a range of bio-psychosocial spiritual conditions
EP 2.1.10d
COURSE METHOD
Didactic presentations/discussions, analysis of videotapes, case discussions, and role
playing, will be used throughout the semester. Students are expected to have read
assignments and cases prior to a given class and should be prepared to participate in
classroom discussions and role plays. Students will not be able to participate in
experiential exercises and class discussions unless they are present in class.
Therefore, class attendance and participation are imperative.
COURSE EXPECTATIONS
Attendance Policy: Students are expected to attend each and every class and to
arrive on time,. Roll will be taken regularly. Students are allowed to miss two classes
without penalty. Three (3) points will be deducted from the final score if one misses
3-5 classes and 5 points will be deducted if one misses 6 or more classes. Students do
not need to notify the professor regarding the reason for their absence(s). Be aware
that tardiness will also affect your final grade
Phones/Pagers: . Phones and pagers disrupt the class. Phones and pagers must be
turned off during class.
Make-up Policy: Make-up exams or extension dates on papers, as a rule, will not be
permitted. Only in extraordinary circumstances may this be considered
((hospitalizations, death of a family member, etc.). The professor reserves the right
to determine the format of any make-up exam or extension dates on papers.
Incomplete Grades: The grade of “I” will be given only under emergency situations
that prohibit a student from completing specific assignments or class projects. The
229
student must contact the instructor and receive approval in writing that an
assignment cannot be completed by the designated date so that the grade of “I” can
be given for incomplete work. A designated time will be given by the professor for
when the work must be completed by the student. If the deadline is not met, the
student will receive a grade based upon work completed for the course excluding a
grade for the specific assignment.
Assignments Policy: All papers must be completed using APA 6th edition
(see www.apastyle.org). That includes, but is not limited to, using double-spacing, as
well as standard fonts (Times New Roman 12) and margins (1 inch on all sides).
Page number requirements do not include the cover page, reference pages or
appendices. While references can be used from a number of sources, references
counted as “required” include only peer reviewed journal articles or book chapters
published from a scholarly press (Columbia University Press, Jason Aronson Press,
Allyn Bacon , etc. ). Other references may be used, however they do not count as a
required references. Late assignments will be penalized as follows: 2 days late – 5
points ; 3-4 days late 10 points; 5 – 7 days late 15 points. Papers will not be accepted
after 7 days.
Communication with Students: All communication with students will be through
KSU e-mail address so that you should check your e-mail regularly.
ACADEMIC INTEGRITY STATEMENT
http://catalog.kennesaw.edu/content.php?catoid=11&navoid=489&returnto=search
#stud_code_cond
Criteria for Student Evaluation
Progress will be evaluated utilizing the following criteria:
Class attendance and participation Three (3) points will be deducted from the final
score if one misses 3-5 classes and 5 points will be deducted if one misses 6 or more
classes.
Assignment
Assignment 1:
Assignment 2:
Assignment 3:
Assignment 4:
Topic
Ethical Dilemma
Antwone Fisher
Psycho. Application Case of Susan
CBT, Psycho-Dynamic, or
Interpersonal Application Case of
Alice
Due
9/6/2011
9/27/2011
10/18/2011
11/22/2011
Points
100 points
100 points
100 points
100 points
Total = 100%
230
Course grades will be assigned as follows:
Percentages for Final Grade
92 – 100%
A
91 - 80%
B
79 - 70%
C
69 and Below
F
231
Course Outline and Readings
Weekly Topics and Readings:
1. Week 1: August 23, 2011
Setting the Stage:
Definition & History of Clinical Social Work; Practice Theory
What is Theory?
The Relationship between Theory and Intervention
The value of theory in Clinical Practice
The Curative Factors in all Practice Theories
Strengths Oriented Clinical Practice; Spirituality
Evidence-based Practice
Ecological Systems Theory (ecosystems)
Becoming a Therapist
DVD: Becoming a Therapist: Inside the Learning Curve from Psychotherapy.
Net
Required Reading:
*Walsh, J. Chapter 2, pp. 17 – 31. (Strengths Oriented Clinical Practice, pp 19-21;
Incorporating Spirituality into Direct Practice – pp. 29-30).
*Cowger, Charles D. and Snively, Carol A., “Assessing Client Strengths” (On Reserve in
Library)
*Borden, W. (2009). Evidence-Based Practice, Science and Social Work: An Overview.
In Roberts & Greene (Eds.) Social Worker’s Desk Reference, pp. 1115-1120.
Oxford Press. (On reserve in Library.)
*Borden, W. (2009). The Life Model/Ecological Perspective. In Roberts & Greene
(Eds.) Social Worker’s Desk Reference, pp. 231 – 235.. Oxford Press. (On
reserve in Library)
Rothery, Michael ( ) “Ecological Systems Theory. (On Reserve in Library)
232
Optional Reading:
•
Goldstein, H. (1990). The knowledge base of social work practice: Theory,
wisdom, analogue, or art? Families in Society, 71, 32-43.
•
Saleebey, D. (2000). Power in the people: Strengths and hope. Advances in Social
Work, 1(2), 127-136.
2. Week 2: August 30, 2011
Ethics and Values in Clinical Social Work
Clinical Vignettes of Ethical Issues Provided by Professor for Class Discussion.
Assignment I: Ethical Dilemma Assignment Due Week 3: September 6, 2011
1. Describe an ethical dilemma you have experienced or know about from your
social work experience (25 points).
2. What action did you take regarding the ethical dilemma? (25 points)
3. Identify and discuss the relevant ethical guidelines as described in the NASW
Code of Ethics. (25 points)
4. Given the ethical guideline(s) discussed, did you take the appropriate action
or would you, in hindsight, take a different action? (25 points)
Required Reading:
NASW Code of Ethics
Reamer, F.G. (1998). The evolution of social work ethics. Social Work, 43, 488-500. (
In Library or can be obtained from University of Georgia SSW or Georgia State
U. SSW)
Borden, W. (2009). Ethical Issues in Social Work.. In Roberts & Greene (Eds.) Social
Worker’s Desk Reference, pp. 115 - 121. Oxford Press. (Available to copy from
Dr. Bowles
3. Week 3: September 6, 2011: View Movie: Antwone Fisher: Assignment 2 Due
Week 6: September 27, 2011
Assignment 1 Due: Ethical Dilemma
Class will complete the required readings and view the movie, Antwone Fisher.
Assignment2: Antwone Fisher ( Due Week 6: September 27, 2011) Based on
233
your readings and viewing of the movie, Antwone Fisher, address the following
questions from the movie.
Each question is worth 20 points for a total of 100 points.
1. What role did Davenport play in Antwone’s life other than his therapist? What
was the quality of the relationship between Davenport and Antwone? What
was Antwone’s contribution to treatment and what role did hope play?
2. What role do you think Davenport’s theoretical orientation plays in Antwone’s
progress? What role did Antwone’s girlfriend Cheryl play in his treatment and
his life?
3. What cultural/class issues are relevant to Antwone’s treatment/therapy? Is
the relationship between Antwone and Dr. Davenport cross-cultural? If so, in
what ways? How are cultural and or class differences addressed?
4. In what stage of change is Antwone at the start of treatment? When and to
which stage does he shift? To what do you attribute that change?
5. Is Davenport an ethical psychiatrist? Why or why not?
Required readings:
Walsh, Chapters 1, pp 1-16.
Tseng, W.S. & Streltzer, J. (2001). Culture & Psychotherapy. Chapter 17; pp. 265-278.
Washington DC: American Psychiatric Press.
*Berzoff, J., Flanagan, Laura M., and Hertz, P. (2008). Inside Out and Outside In (2nd Ed.
New York: Jason Aronson. Chapter 14 by Lourdes Mattei, “Coloring
Development: Race and Culture in Psychodynamic Theories”, pp. 245-271.
234
Optional readings:
Harper, K.V. & Lantz, J. (1996). Cross-cultural Practice. Chicago: Lyceum. (Chapter 1:
Cross-cultural curative factors.)
4. Weeks 4 & 5: September 13 & 20, 2011
Week 4: September 13, 2011:
Psychodynamic Theories I: Ego Psychology
Ego Psychology and Ego Functions
Common Mechanisms of Defense
Evaluation of Defenses
Week 5: September 20, 2011;
The Autonomous Ego Functions
Case: The Girl in the Window
Specific Ego Intervention Strategies
Ego Psychology and Principles for Terminating with Clients
Ego Psychology and Social Justice Issues
Ego Psychology and Spirituality
Role Plays: The Post Traumatic Stress Survivor, In Walsh, pp. 53-55
Psychosocial Ego Development Theory of Erik Erikson;
Role Play Using Ego Psychology Strategies. CASE: : The Post Traumatic Stress
Survivor, pp. 53-55 taken from Direct Social Work Practice by Joseph Walsh.
You are to read the entire case. The Role Play will be based on the 4th Paragraph of
the Case found on page 53, which begins: “After their fourth session, Heidi’s
depression and anxiety increased.” Four ego psychology strategies are listed below
and there will be four (4) role plays with 8 students. For each Role Play, one student
will be the SW and the second student the client. The Role Plays will demonstrate one
of the Ego Psychology Strategies listed below.
1. With the information you know, do a beginning interview that
demonstrates sustainment or establishing a relationship with Heidi.
235
2. Do an interview that demonstrates Exploration/Description/ Ventilation
and Person Situation Reflection.
3. Do an interview that demonstrates Partializing (Structuring) and
Education.
4. Do an interview that demonstrates Developmental Reflection
Required readings:
Walsh, Chapter 3 – Ego Psychology, pp. 32 - 61
Berzoff, “Inside Out, Outside In: An Introduction, pp. 1-15 and Chapter 4, “Ego
Psychology”, pp. 63-97.
Berzoff, Chapter 5, “Psychosocial Ego Development: The Theory of Erik Erikson, pp. 99
– 120.
Optional readings:
Malick, M.D. (1991). Re-assessing assessment in clinical social work practice. Smith
College Studies in Social Work, 62, 3-17.
6. Week 6: September 27, 2011
Assignment 2 Due: Antwone Fisher
Psychodynamic Theories II: Object Relations Theory
Object Relations Theory
Early Nurturing and Attachment Theory
Two Object Relations Theorists: Donald Winnicott and Margaret Mahler
Margaret Mahler’s Separation/Individuation Phases
Assessment and Intervention
Required readings:
Walsh, Chapter 4 – “Psychodynamic Theories II: Object Relations Theory”, pp. 62 –
89.
Berzoff, Chapter 6, “Object Relations Theory” by Laura Melano Flanagan, pp. 121160.
236
Berzoff, Chapter 8, “Attachment Theory” by Robert Shilkret and Cynthia Shilkret, pp.
189-204.
Bowles, Dorcas (1983). Ethnicity and Race: Critical Concepts in Social Work.
Washington, D.C. NASW Press. “ Development of an Ethnic Sense of Self” using
Object Relations Theory (On Reserve in Library)
Optional reading:
Borden, W. (2009). Object relations psychology. In Roberts & Greene (Eds.) Social
Worker’s Desk Reference, pp. 305-310. Oxford Press. (Available to copy from
Dr. Bowles.)
7. Week 7: October 4, 2011
Psychodynamic Object Relations Theory and Gender
Object Relations and Social Justice
Object Relations and Spirituality and Principles for Terminating with Clients
Diversity and Cultural Factors: Issues faced by Majority Workers with Clients of
Color and by Workers of Color working with Clients of Color (Class Discussion)
Case Discussion - The Wild Child (Walsh, pp. 79 – 82)
Required readings:
Berzoff, Chapter 10, “Psychodynamic Theory and Gender”, pp. 229-244.
Berzoff, Chapter 11, “Coloring Development: Race and Culture in Psychodynamic
Theory” by Lourdes Mattei, pp. 245 – 270.
Optional readings:
Chapter 5 – Family Emotional Systems Theory
Dalzell, Heidi J. (2001). Insight at any age: Psychodynamic treatment of older adults.
Psychoanalysis & Psychotherapy Vol 18(2), 241-260. (Available to copy from
Dr. Bowles.)
Messer, S.B. (2002). A psychodynamic perspective on resistance in psychotherapy:
Vive la resistance! Journal of Clinical Psychology, 58(2), 157-163.
237
8. Week 8: October 11, 2011
Personality Disorders (also known as Character Disorders) with a Special
Emphasis on Borderline and Narcissistic Personalities
Meaning of Term Personality Disorder or Character Disorder
Borderline Personality Disorders
Borderline Personality in Context of Person’s Object Relations, Ego Functions and
Sense of Self
Review of Object Relations Chart
Case: Mary Ann F.: A Borderline Mother and her New Born
Narcissistic Personality Disorder
Narcissistic Personality in Context of Person’s Object Relations, Ego Functions and
Sense of Self
Required Reading:
Berzoff, Flanagan and Hertz, Inside Out and Outside In, “Personality Disorders with a
Special Emphasis on Borderline and Narcissistic Personalities. Chapter 14, pp.
311-354.
Walsh, pp. The Nature of Problems and definition of “Splitting”, pp. 74-75.
Borden, W. (2009). Interventions with Borderline Personality Disorder. In Roberts &
Greene (Eds.) Social Worker’s Desk Reference, pp. 305-310. Oxford Press, pp.
742 – 751. (Available to copy from Dr. Bowles.)
9.Week 9: October 18, 2011
Assignment 3: Psychodynamic Application Paper Due: Case of Susan: Week 9,
October 18, 2011
Narcissistic Personality Disorder Continued
Behavioral Theory
Intervention Techniques Using Behavioral Theory
Social Justice Using Behavioral Theory
Spirituality Using Behavioral Theory
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Required readings:
Walsh, Chapter 6 – Behavioral Theory
10.Week 10: October 25, 2011
Behavioral Theory Continued to include
Spirituality
Social Justice
DVD: Cognitive Behavioral Therapy with John Krumboltz
Required readings:
Borden, W. (2009). Cognitive-Behavioral Theory. In Roberts & Greene (Eds.) Social
Worker’s Desk Reference, pp. 305-310. Oxford Press. (Available to copy from
Dr. Bowles.)
Borden, W. (2009). A Behavioral Approach to Social Work Treatment. In Roberts &
Greene (Eds.) Social Worker’s Desk Reference, pp. 288 - 294. Oxford Press.
(Available to copy from Dr. Bowles.)
Rokke, P.D. & Rehm, L.P. (2001). Self-management techniques. In K. Dobson (Ed.),
Handbook of Cognitive-Behavioral Therapies, pp. 242 - 247. New York: Guilford
Press.
11. Week 11: November 1, 2011
Cognitive Theory
Assessment
Intervention
Cognitive Theory and Social Justice
Cognitive Theory and Spirituality
DVD: Depression: A Cognitive Therapy Approach with Arthur Freeman, Ed.D
Required readings:
Walsh, Chapter 7 – Cognitive Theory
239
Borden, W. (2009). Cognitive Restructuring Techniques. In Roberts & Greene (Eds.)
Social Worker’s Desk Reference, pp. 588-594. Oxford Press. (Available to copy
from Dr. Bowles.)
Optional readings:
Beck, J.S. (1995). Cognitive therapy: basics and beyond. New York: Guilford. (On
Reserve)
Interpersonal Therapy and Structural Family Theory
12. Week 12: November 8, 2011
Interpersonal Therapy and Structural Family Theory
Interpersonal Therapy
Interpersonal Therapy
Elements of Psychodynamic Theory
Elements of Cognitive and Behavioral Theory
Assessment
Intervention
Interpersonal Therapy and Social Justice
Interpersonal Therapy and Spirituality
Case: The Rose from Spanish Harlem – Class Discussion (Walsh, pp. 187 -192
Structural Family Theory
Major Concepts and Other Concepts
The Nature of Problems and Change
Assessment
Interventions Ending Structural Family Therapy
Structural Family Theory and Social Justice
Structural Family Theory and Spirituality
DVD: Structural Family Therapy with Harry Aponte, LCSW
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Required Readings:
Walsh, Chapter 8 – “Interpersonal Therapy”, pp. 177 -198.
Walsh, chapter 9 – “Structural Family Theory”, pp. 199 – 229.
13. Week 13: November 15, 2011
Structural Family Theory Contd.
Narrative Therapy
Narrative Theory Defined
Major Concepts of Narrative Theory
Assessment using Narrative Theory
Interventions Using Narrative Theory
Terminations and Narrative Therapy
Narrative Therapy and Spirituality
Narrative Therapy and Social Justice
Case: Bag Lady – Walsh, pp. 289-291 and Case Examples from the Class
Required readings:
Walsh, Chapter 12 – Narrative Theory
Optional reading:
Goncalves, O.F., Machado, P. P. P. Korman, Y., Angus, L. (2002). Assessing
psychopathology: A narrative approach. In: L.E. Beutler & M.L. Malik (Eds.),
pp. 149-176. Rethinking the DSM: A psychological perspective. Washington DC:
APA.
*Borden, W. (2009). Narrative Therapy. In Roberts & Greene (Eds.) Social Worker’s
Desk Reference, pp.273-276. Oxford Press. (Available to copy from Dr. Bowles.)
14. Week 14: November 22, 2011
Assignment 4 Due: Cognitive Behavioral, Psychodynamic or Interpersonal
Theory- Practice Application Paper Due
Case of Alice (Select one theoretical Perspective)
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Narrative Therapy Cont’d
(Fall Break – No Classes – November 23 – 27, 2011)
15. Week 15 Wednesday November 29, 2011
Time Limited Dynamic Psychotherapy
Definition of Time Limited Dynamic Psychotherapy
Five Essential Assumptions of TLDP
Two Goals of TLDP
Five Major Criteria used in Determining Clients’ ability to benefit from TLDP
How the SW obtains data that will be used to show that there is a Maladaptive
Pattern
DVD: Time Limited Dynamic Psychotherapy by Psychotherapy Net. Dr. Hannah
Levenson, Therapist. Psychotherapy. Net
Questions for Class Discussion following a Review of the DVD
1. Did Mr. Johnson, the client, demonstrate the five essential assumptions of
Time Limited Dynamic Psychotherapy?
2. Why does Dr. Levenson push Mr. Johnson so hard to talk about his feelings in
spite of his insistence that he is unable to do so?
3.
When Dr. Levenson interprets Mr. Johnson’s disclosure of his feelings of
disappointment, do you agree with her linking the feelings with
abandonment?
4. What was most helpful to you as a SW about the TLDP model? What
perspectives did you find helpful and might use in your own work?
5. What do you think you would have done differently than Dr. Levenson, the
therapist, in the video? Be specific in what different approaches and
techniques you might have applied and state why you would use these
different approaches.
203
Required readings:
Levenson, Hanna, “Time Limited Dynamic Psychotherapy”, from The Art and Science
of Brief Psychotherapies, pp. 157 -184. On Reserve in Library
Walsh, Chapter 13 – Crisis Theory & Intervention
Eaton, Y.M. & Roberts, A.R. (2004). Frontline crisis intervention. In Roberts & Greene
(Eds.) Social Worker’s Desk Reference, pp. 89-96. Oxford Press. (On Reserve)
16. Week 16: December 6, 2011: Final Class (Final Exam Week: December 6 12, 2011
Motivational Interviewing
Definition of Motivational Interviewing
Transtheoretical Stages of Change (TSOC) Model – A Major influence of
Motivational Interviewing
Clinical Perspective in Motivational Interviewing
The Social Worker Client Relationship and Assessment in Motivational Interviewing
Intervention in Motivational Interviewing
Specific Techniques used by the Social Worker in Motivational Interviewing
Developing a Change Plan Technique that Supports Self –Efficacy
Motivational Interviewing and Spirituality
Motivational Interviewing and Social Justice
DVD: Client Mike by William Miller. developer of Motivational Interviewing,
Psychotherapy Net Video Collection – Enhance Your Training Program
Termination with Clients
Professor’s Closing Comments
Required readings:
Walsh, Chapters 12 – Motivational Interviewing, pp. 253-272
Walsh, J. (2003). Endings in Clinical Practice. Chapters 2 & 3; pp. 22-56. Chicago:
Lyceum Books. (Available on WebCT)
204
O’Leary Tevyaw, T. & Monti, P.M. (2004). Motivational enhancement and other brief
interventions for adolescent substance abuse. Addiction, 99, 63-75,
Supplement 2.
Berzoff, Chapter 18, pp. 443-446.
Optional reading:
Elks, M.A., & Kirkhart, K.E. (1993). Evaluating effectiveness from the practitioner
perspective. Social Work, 38(5), 554-563.
Mercier, C., Landry, M., Corbiere, M. & Pereault, M. (2004). Measuring clients’
perception as outcome measurement. In Roberts & Yaeger (Eds.), EvidenceBased Practice Manual, pp. 904-909. Oxford Press.
PLEASE NOTE: You will be doing one assignment on an ethical issue, one assignment
based on the film, Antwone Fisher, and 2 application of practice papers. Each paper
should be between 10-15 pages long, double-spaced. If the papers can be completed
in fewer than 15 pages that is fine. If the paper is a page or two longer than 15 pages
that is also fine. Remember: More does not mean better. They are due at the
beginning of each class as follows:
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Case of Susan
Family Service Agency
Case Study: Susan
Identifying Information
Susan is a 40 year old Caucasian woman. She identifies herself as lesbian; has never
been married and has no children of her own. She has been unemployed for roughly
6 years, although she did at one time have a “high paying job” of about $45,000 a year
as a locksmith. In addition to her salary, Susan often received good tips for her work
as a locksmith. Susan currently collects Social Security Disability Insurance (SSDI) as
a result of severe back problems she has had since childhood, based in part on
beatings she received at the hands of her Father and beatings from her lesbian lover,
Tina and Tina’s boyfriends. Susan was in a 12 year lesbian relationship with Tina
who had two daughters, J and T. The two daughters were by two of Tina’s former
boyfriends. Susan does not attend church regularly, but when she does, she attends a
Unitarian Church.
Description of Client
Susan presents as a very thin woman who looks older than her 40 years. Her face
and neck are scarred with slashes and discolorations and her cheeks are drawn in
from a recent drastic loss in weight. She walks slowly and with a cane. She has eight
teeth remaining and reports intense pain in her face because these teeth are
decaying. Susan’s teeth were basically knocked out during fights with Tina and
Tina’s boyfriends. She is in need of glasses and her eyes squint. She often uses her
hands to cover her mouth as a way of not letting others see that most of her teeth are
missing.
Susan speaks in a slow pace, with very little emotional inflection and often stutters
when discussing painful memories experienced from her childhood in relationship to
physical abuse by her father, sexual abuse by her siblings, and adult life with her
lover, Tina, and Tina’s boyfriends who also severely physically abused her. Susan
often uses humor to describe some of her more painful memories. She graduated
high school, but reports she can read only at about a 6th grade level. She loves
working with her hands and took courses that led her to becoming a locksmith which
she was good at until she was forced to give up being a locksmith because of severe
back injuries. At the beginning of TX, Susan’s affect was somewhat labile, changing
from angry to defensive, to sad, hopeless, and somewhat apologetic. During the
initial interviews, Susan described her recent loss of a 12 year relationship with Tina,
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a female lesbian partner, and her two female children, J and T, that Susan and Tina,
raised together. Early meetings with the SW focused on Tina’s leaving/abandoning
Susan and taking the two girls, J and T, that Susan had come to love and become
attached to, with her. Susan felt she was a parent to the two girls and that she could
see sadness in the faces of the two girls when Tina left with them. Susan experienced
feeling sad, depressed and “out of sorts” when Tina took the two girls, J and T and
left. In later meetings with the SW, Susan would become unable to think of anything
else except her memories of childhood physical and sexual abuse by her father, two
brothers and older sister.
Susan lives in a private single room of a large boarding house that she rents. There
are 4 other female residents in the boarding house where the 4 tenants share a
bathroom and a kitchen. Susan has had this living arrangement since the breakup
with her girlfriend, Tina. Near the end of TX, Tina moved into a one room apartment
where she currently resides.
Referral
Susan was a “walk-in” client to the Family Service Agency which was about two
blocks from the boarding house where she lived. One of the other female boarders
had indicated that she had previously received help from the agency, and Susan
decided to seek help on her own. Susan told the intake SW that she would “really
appreciate someone to talk to because things are falling apart for me, and I cannot
figure things out.” The Intake SW did a brief intake interview and Susan was
assigned to a 2nd year SW student from a graduate school of social work. Meetings
were planned for once per week with the MSW intern.
Family History
Susan is the youngest of five children: two older brothers and two older sisters.
Susan was sexually molested for years by her two older brothers and by the older
sister. Susan had a fairly good relationship with the sister who was 2 years her
senior and next to her in age. Susan remembered that the sexual abuse happened to
her between the ages of 8 and 13. Susan stated that the two older brothers often
molested her individually and together as a team, and she does not feel that the
brothers knew that the oldest sister was also sexually molesting her. The oldest
sister was later hospitalized for psychiatric reasons, and later developed MS. In
addition to being molested by her siblings, Susan stated that a total of 11other men
had sexually abused her, some family members and others neighbors and friends of
the family. Susan’s father was an alcoholic and she reported being beaten by her
father as well as witnessing the Father severely physically abuse her mother. He (her
father) always beat the Mo. in the kitchen. The father gave the Mo. a skull fracture in
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the back of her head and Susan is certain that this blow led to the aneurism that
subsequently killed the Mo. Susan was age 13 when her Mo. died and has been on
her own pretty much since then.
Treatment Sessions
Susan was in a lesbian relationship for 12 years with a woman, Tina, ten years her
senior. Susan was age 28, and Tina age 38, when the lesbian relationship began. Tina
had two female children, J and T, by two different men, and the two children also
lived in the household. Susan experienced physical and emotional abuse in the
relationship with Tina. When Susan first talked about Tina, she alternated between
seeing her as evil and as a “good woman with a good heart.” Although Tina had left
Susan 9 months earlier when TX began, Susan felt responsible for the failed
relationship. Susan could not have children and came to develop positive feelings
toward the two female children, J and T, who were Tina’s children by different men
prior to Susan’s and Tina’s relationship. Also, when Susan met Tina, Susan was
working and making a fairly good salary, of approximately $45,000 per year, as a
locksmith. Tina was unemployed and was basically being taken care of sporadically
by the children’s fathers and other men with whom she had relationships. Susan
supported Tina and her two children and became very emotionally attached to the
two girls. As far as Susan knows, Tina was in relationships with males prior to their
becoming lovers, and she is Tina’s first lesbian relationship.
Tina was very physically abusive to Susan during the 12 year relationship, and Susan
initially blamed herself for Tina’s abuse of her. Susan stated: “It’s my fault for
bringing a straight woman out as a lesbian. Tina beat me and cheated on me and I let
her. It’s my fault. I came to love Tina and her two daughters and now I have no-one.
Tina is the only person who loved me other than my Mo., but my Mo. could not show
her love to me, because she was physically abused by my Fa. and was depressed all
the time.” Tina would punch Susan in the face, chest and stomach, and throw chairs,
vases and other large objects at her, some of which hit Susan in the face and on
various other parts of her body. Often the fights with Tina were about boyfriends that
Tina brought to the house. Tina had boyfriends throughout the relationship with
Susan and the boyfriends also physically abused Susan. More than one of Tina’s
boyfriends physically beat and abused Susan. Tina would watch these fights and “egg
the boyfriends on” as they physically beat and abused Susan. Susan felt the beatings
from Tina and her boyfriends were her fault because she was bad and deserved the
beatings. Oftentimes, the fights with Tina’s boyfriends started when Susan would yell
at the boyfriends that Tina did not love them, but loved Susan.
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One of Tina’s boyfriends had held a gun to Susan’s head and Susan had said: “Go
ahead – put me out of my misery.” Another of Tina’s boyfriends, broke Susan’s cheek,
knocked three of her front teeth out, and smashed her glasses. Susan stated that she
has gotten hit in the head so much and tried to abuse herself so much with drugs that
she wonders if her brains aren’t fried. Susan stated that sometimes it feels like
there’s so much noise in her head, like a banging back and forth. She has headaches
all the time. She knows that the headaches are related to the abuse she received as a
child from her father and from fights with Tina and her boyfriends.
During Susan’s and Tina’s relationship, Susan rented an apartment that consisted of
two bedrooms; 2 baths with one bath connected to the large master bedroom and the
other bath off of the 2nd bedroom; a large living room; dining room; kitchen with a
large pantry; and a small Den which was used to watch TV. The apartment provided
a place where Tina and her girls could live. The girls shared one bedroom and bath
and Susan and Tina the master bedroom and bath. Susan was doing well health-wise,
until she began to experience severe beatings at the hand of Tina and Tina’s
boyfriends, which worsened a back problem she had from beatings she experienced
at the hand of her father. Susan’s back problems worsened and resulted in her not
being able to continue her work as a locksmith and having to receive Social Security
Disability Insurance (SSDI). Once Susan began receiving SSDI, she lost the apartment
because it was too expensive; Tina and the girls left; and Susan was only able to
afford a room in a boarding house where she currently lives.
Tina would occasionally bring the two girls, J and T, to visit Susan, often accompanied
by a new boyfriend. Tina was also able to get Susan to give her small sums of money
for the girls which Susan could not refuse because she had become attached to the
girls and wanted the best for them. Once Tina got the money from Susan, she would
leave. If Susan asked if the girls could stay with her for a while longer, Tina would
say No and snatch the kids and leave. Susan is sure the girls were confused as they
would often turn to look at Susan as though they wanted to stay, but Tina would rush
them out without Susan and the girls being able to say good-bye. Susan says that she
felt overwhelmed, was not able to sleep, was more overwhelmed than she had ever
been, and would be upset that if she did not do what Tina said, she would not be able
to see the girls. Susan felt she had lost everything - her job, her health, the
apartment, Tina, and the girls. Susan has no contact with members of her family who
live in another state. Susan felt she had no one and could not live without Tina and
the girls.
Part of TX focused on helping Susan to see that she is separate from Tina and the
girls and that she can have a life separate from them. During these sessions, Susan
would cry incessantly because she felt her life was over without Tina and the girls.
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Gradually, with the SW’s help, Susan began to see some of her strengths and that her
relationship with Tina was “exploitative”; that Tina was “manipulative” and that she
could live without Tina and the girls. It took several sessions for Susan to begin to
internalize that she had strengths and to begin to “feel whole” and worthwhile as a
person without Tina and the girls.
During this time, as Susan was beginning to feel comfort with herself, she would
occasionally express feeling empty without Tina and the girls in her life and she
began to drink again. Susan stated that on one occasion, she drank a fifth of tequila
to make the pain inside her go away. She does not want to drink because she has
been through “drinking binges” before. In the past, Susan would drink heavily,
especially after beatings from Tina and/or Tina’s boyfriends. The last time Susan
drank tequila, following a beating by one of Tina’s boyfriends, she spent 3 days
praying to the porcelain God she had in her apartment. Susan stated that she feels
tired. So tired, she just wants to crawl in her shell. She wants to be alone; she’s tired;
wants to go to her room and lay there. She thinks about her Mom; listens to the cars
go by; does not think of anything; does not want to go out to get food or groceries.
She only wants to walk around in her room by herself. Susan expressed that at these
time, being alone allows “me to think about and process what we talk about during
our sessions; this makes me feel stronger and allows me to think of my past and
where I am in my life without Tina and the girls. I hold on to these thoughts and it
gets me through these rough spots until I can speak with you again.” The SW
commented that what Susan has just described represents growth on her part and
that given her past, it takes time for healing to occur. Susan has done a lot of hard
work to get to this place and the SW expressed that she is proud of the progress Tina
has made. Tina was teary eyed and said: “I could not be at this place were it not for
our time together. Thanks for all you have done to help me.” The SW explained to
Tina that Tina had done the work and she should feel proud of what she has
achieved. Tina thanked the SW for caring about and being there for her. “I would
probably be dead if I did not have you”, Tina stated.
The Family Service Agency used a psychiatrist for consultation services and the SW
referred Susan to the psychiatrist for a psychiatric exam for her depression and
“feelings of emptiness” and she was placed on meds for her depression. Susan stated
the meds have helped her feel better and less depressed. As well, Tina had not
visited Susan for several months and Susan was doing better; feeling stronger. Susan
had been saving money and living frugally with the goal of moving to a small
apartment. She was able to find a small apartment she could afford, was able to pay
the required deposit, and was making plans to move.
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Then, several weeks later on a Saturday, Tina brought Susan food but did not bring
the girls. Susan had not seen Tina for several months and was feeling that she was
getting herself together and ready to move on with her life. Susan and Tina ate some
of the food Tina brought, and talked about things in general and the discussion went
well. Susan told Tina that she had put a deposit on an apartment and planned to
move soon.
On the next day, Sunday, Tina brought the girls to see Susan. Tina knew from talking
with Susan on Saturday, that Susan planned to move to an apartment. On that Sunday
when Tina brought the girls to see Susan, Tina talked about the possibility of she and
Susan getting back together and trying to make the relationship work. Susan was
quite surprised and explained to the SW in her next session, that she did not trust
Tina so she just took the information in without commenting. Tina still has her
boyfriends and Susan feels that Tina wants another “free ride”, but Susan is not
prepared to get involved with Tina again. Susan was finally able to see and realize
that Tina had “used me so she and her two daughters could live rent free” in Susan’s
apartment and have food and bills paid by Susan. The SW could see that Susan’s
understanding and insight, based on their work together and the gains made in TX,
were remarkable.
Susan was finally able to see that her relationship with Tina was exploitative, abusive
and unhealthy.
Susan explained to the SW that based on the work she had done in TX with the SW,
she is feeling better, feeling stronger and does not want to return to the place she
was at earlier. Susan stated that she knows that Tina is not good for her and it has
taken some time for her to work out her feelings regarding Tina and the abuse she
experienced with her and the abuse she experienced at the hands of her father. She
does not want to and does not deserve to get hurt again. Susan repeated what the SW
had told her on several occasions: “As you said, I can be my own person and am
worthy and deserving of a better life.”
With the SW’s help, Susan was able to explain to Tina that it had taken her a long
time to work through the abuse she had experienced with Tina and her boyfriends.
Susan stated that she loved J and T and wanted the best for them, but felt it was in
everyone’s best interest that she and Tina not get back together. Susan stated that
she would miss the girls, J. and T., but needed to get on with her life and Tina and the
girls needed to get on with their lives. Tina was angry and wanted to start a fight, but
Susan held her ground and said she needed to move on and did not want to repeat
the pain of the past.
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Tina tried to get Susan to give her the address where she was moving, but Susan said
she could not give her the address. They needed to say good bye. Tina tried to turn
the cards and say that she did not want a relationship with Susan and never wanted
to see Susan again. Also, she would make sure Susan never saw the girls. J and T.,
again. Susan attempted to give Tina a hug good bye and to tell the girls good bye and
give them a hug, but Tina pulled away and took the girls’ hands and left without any
goodbyes. Susan felt sad that things ended this way, but felt she had to protect
herself and would not allow Tina to “manipulate” her further. (The word manipulate
had been used by the SW to explain Tina’s relationship with Susan.)
Susan moved to her new apartment. It is a small one bedroom apartment, and she
has spent time fixing it up and is enjoying having time to herself and doing things she
enjoys. She attended church last week and re-connected with a woman, Judy, she
had known earlier when she attended church. She and the woman have had coffee
together and gone to a few movies. These were things Susan once enjoyed but had
not done when she was living with Tina. Susan feels good that she is doing things she
enjoys. The woman is divorced and “straight” and Susan enjoys her company. Susan
has stated that this is the first time she has ever had a “real friend” that she can talk
and share her ideas with. Susan has explained to Judy that she is a lesbian and the
woman has expressed that while that is not her lifestyle, she respects Susan and her
lifestyle. Susan stated that Judy is okay with Susan being a lesbian and Judy being
straight and respected Susan for being who she is and Susan is fine with Judy being
straight and her own person. Judy has had several other church members to her
house for special occasions and Susan has gone and has had a good time. Susan feels
she wants an intimate female relationship, but feels that until she finds a “good,
healthy” relationship that is not “exploitative and manipulative”, she is fine.
The student SW left the agency to return to school and Susan was quite sad and
depressed when she left. The student SW transferred Susan to another worker in the
agency and Susan continued to see the other SW. The new SW explained that it was
natural for Susan to feel sad at the loss of the student SW. The two of them had
worked hard together and it was natural that Susan would miss her. Gradually,
Susan’s sadness lessened as she got to know the new SW and felt comfortable talking
with her.
After several months, the new SW expressed to Susan that she felt Susan was at a
place where she no longer needed to see the SW. Susan was hesitant at the idea
initially but agreed to a plan where Susan would continue to be seen weekly for
another month after which Susan would be scheduled to come every two weeks.
Prior to the change to being seen once every two weeks, the SW and Susan talked
about Susan’s feelings about the change and what Susan might feel and that they
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would monitor Susan feelings to determine if the change in schedule was okay for
Susan. This same process was followed for scheduled appointments on a once per
month basis. Susan did fine with the changes and the SW introduced the idea that
Susan was ready to be on her own with the understanding that Susan could call the
agency should she have other issues she wanted to address. Susan accepted this final
arrangement and acknowledged that the gradual reduction in visits had been good
for her and had allowed her to prepare for being on her own. Susan expressed that
she is indebted to the student SW and the current SW for “saving my life and helping
me feel whole and complete”. Susan has been on her own now for some time. She
has only called the new SW on one occasion when she was feeling sad and needed to
process her feelings. The SW and Susan were able to talk on the phone and Susan felt
this was adequate. Susan knows that the agency is there for her should she need to
contact them. Susan has made no further calls to the agency.
ASSIGNMENT 3: Due: Week 9: October 18, 2011
Psychodynamic Application of Theory: Case of Susan
Application of Psychodynamic Theories (Object Relations and Ego Psychology)
to Case of Susan.
Answer each question. Be sure to number and state the question before each
response so that I know the answer that corresponds with the question.
Questions:
1.
Based on the information given in the case-study, (a) what are Susan’s
strengths? Where would you locate Susan developmentally and why? (b)
provide the characteristics of the developmental stage with specific
information from the case study that support your choice; and (c) describe
treatment interventions used by the SW to support Susan in moving from the
stage you have selected to a different/higher stage. (20 points)
2. The relationship between Susan, Tina, and Tina’s boyfriends was quite
abusive. How do you explain Susan’s acceptance of the physical abuse from
Tina and Tina’s boyfriends. (20 points)
3. Based on lectures and readings, (a) assess Susan’s ego functioning (b) What
areas of ego functioning are working well? (c) What ego functions are not
working well? (c) What ego defenses is Susan using? Give specific examples.
(20 points)
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4. You are assigned as Susan’s social worker: (a) are there additional
interventions you would use? Why? Why not? (b) Would you refer Susan to
any other professional(s)? Identify professionals; explain reason for referral(s
(c) Explain how you would work with/coordinate with the other
professionals? ); (If you would not refer Susan to any other professional(s),
explain why. (20 points)
5. Explain the role of the student SW and give your assessment of the
relationship she formed with Susan and your thoughts about her TX of Susan.
Describe your thinking with regard to how the new SW handled the
termination with Susan and whether the handling was clinically appropriate
or clinically inappropriate. Explain your response. Be specific (20 points)
Case Study: Alice
Agency Setting: A Mental Health Agency
Identifying Information:
Alice is a 23 year old Caucasian, married female who is currently unemployed. She’s
been married for six years to her first and only husband, Joe. Alice was referred by
her primary care physician after no physical causes could be found for feelings of
chronic depression, fatigue, anxiety, migraine headaches and stomach aches during
the last three years. Approximately six months ago, Alice was fired from her job as a
cashier at a drug store. Since that time, she states that she spends most of her time
taking care of her pets: three dogs and two cats, and making crafts.
Alice is soft-spoken and describes herself as shy, dependent, and easy to feel hurt and
quick to feel guilty. In the past three weeks, she has been experiencing significant
levels of sadness, depression, anxiety and low self-esteem. She denies any suicidal
ideation. She states that she is very inhibited when it comes to talking about and
dealing with emotionally charged and disturbing issues and avoids such topics as
much as possible. Alice describes her husband as very supportive and hard-working.
She states that there are no difficulties in their marriage and she is very satisfied
being married to Joe.
Alice reports that she and her husband have tried
unsuccessfully since they have been married to have children.
Alice reports that when she was four years old, her mother, grandmother, and
grandfather all died in a car accident of which she was the only survivor. She claims
that she has no memories of the accident itself or of her biological mother. Alice
related the onset of her current symptoms to a time three years ago when she had
taken a trip to Texas to visit some of her relatives on her mother’s side of the family.
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At that time, she learned some of the details of the accident from her mother’s
relatives.
She stated that she had difficulty tolerating the return drive home,
especially on two lane roads. Since then, she has had dreams of the accident and has
been unable to drive a car herself.
Alice also reported that an elderly friend of hers, Sam, who has been a father figure to
her since she was a young girl, committed suicide about six months ago. Alice says
that since that time the dreams of the accident, as well as dreams of Sam, have been
more frequent.
FAMILY HISTORY:
Alice reported that her father was married once before his marriage to her mother
and twice after her mother’s death. Alice has a half-sister from her father’s first
marriage and two older siblings from his marriage to her mother. In addition, she
has two step-siblings from her father’s last two marriages. Alice says she had a great
deal of difficulty with her first step-mother when she was growing up. She described
her first step-mother as alcoholic and physically abusive of one of her sisters. This
step-mother also gave Alice a black eye once. Alice described her second stepmother as rejecting and not wanting to deal with Alice since this woman’s own
children were already gone. Alice reported that at age 16, she began running away
from home and staying out late at night and drinking and occasionally smoking
marijuana with friends. She says that this lasted for about one year and that she was
able to quit using alcohol and marijuana on her own. At age 17, Alice moved out of
the house and lived first with an aunt, then with her best friend and family, and
finally with her boyfriend (now her husband) and his family.
Alice stated that her primary reason for seeking social work intervention is to try to
remember and learn as much as she can about the accident that killed her mother
and grandparents and remember and learn as much as she can about her mother as a
person. She stated that her father had always discouraged her from talking about her
deceased mother when she was growing up. Alice wants to stop feeling depressed
and anxious and also start feeling better about herself.
She believes that
remembering and learning about her mother and the accident will help her do this.
In addition, she would like to get to the point where she is able to work and drive a
car again.
Application of Cognitive Behavioral or Psychodynamic Theory: Case of Alice
Due Week 14, November 22, 2011
215
You are the social worker assigned to work one-on-one with Alice, the young woman
in the assigned case at the Mental Health Agency. You can select either the Cognitive
Behavioral theoretical perspective, the Interpersonal theoretical Perspective or the
Psychodynamic theoretical perspective as your frame of reference in working with
Alice. Please state your choice of theories first and briefly justify your choice as it
relates to the case. You are to choose only one theoretical perspective, even if in real
practice, you would choose to use parts of both theories.
Answer each question. Be sure to number and state the question before each
response so that I know the answer that corresponds with the question.
Questions:
State your theoretical perspective. (0 points)
Justify or state why you have chosen a particular theoretical perspective for your
work with Alice. (0 points)
1. Provide an understanding of Alice’s issues that is congruent with your chosen
theoretical perspective to include: (a.) a list of Alice’s strengths;(b) a
description of the problem(s) as it would be explained by your practice
theory; and (c) potential reasons for the problematic behavior(s) as explained
by your theory. (20 points)
2. Based on the information you have provided to Question No. 1, provide: (1) a
treatment plan including at a minimum two (2) treatment goals that are
congruent with Alice’s strengths and the theory you selected; and (2) the
approximate length of time you will need to achieve the goals selected and
why. (20 points)
3. Describe at least two interventions you might use in this case based on the
theory you selected and Alice’s strengths. Discuss how the interventions
relate to the treatment goals and how they would be implemented. (15
points)
4. Would your conceptualization and/or intervention be different if Alice were
described as a Mexican-American woman? Why or why not. If yes, describe
the differences. (20 points)
5. Describe two ways in which you would evaluate Alice’s progress. What would
you measure? How and when would you measure it? (15 points)
216
6. What do you anticipate would be Alice’s response to termination and how
would you handle the termination including how and when you would inform
Alice of the termination. (10 points)
Glossary of Concepts
Psychodynamic Theory: Object Relations
Dorcas D. Bowles, Professor
Consolidation of Individuality and Emotional Constancy
The fourth sub-phase of separation individuation, which begins toward the end of
the second year is open-ended. During this period, a degree of object constancy is
achieved, and the separation of self and object representation is sufficiently
established. Mother is clearly perceived as a separate person in the outside world,
and at the same time has an existence in the internal representational world of the
child.
Emotional Refueling
During the practicing and rapprochement sub-phases, the infant moves away from
the mother, but when s/he becomes fatigued or depleted of energy, s/he seeks to reestablish bodily contact with her. This “refueling” perks the toddler up and restores
his/her previous momentum to practice and explore.
Mutual Cueing
A circular process of interaction established very early between mother and infant by
which they “empathically” read each other’s signs and signals and react to each other.
For example, the mother learns the meanings of the baby’s different cries and
movements: the baby learns to anticipate the mother’s ministrations: s/he also
learns soon which cues the mother (unconsciously) picks up and which she does not.
No mother perfectly responds to a baby’s cues, but serious mismatching of cues is an
obstacle in the path of smooth development.
Shadowing and Darting Away
During the rapprochement sub-phase, the child, at times, follows his/her mother’s
every move (“shadows” her); s/he cannot let the mother out of sight or out of his/her
vicinity. At times, we observe the opposite behavior, the child darts away, and waits
for and expects the mother to swoop him/her up in the mother’s arms and thus for
brief moments undo the “separateness”.
217
Ambivalence
Ambivalence can occur only when there is representation of a single, whole person.
Separation/Individuation has to have occurred at least in its beginning stage. The
person can tolerate mixed feelings occurring at the same time; can tolerate good and
bad feelings being present in the same person.
218
Glossary of Concepts Psychodynamic
Theory: Object Relations Dorcas D.
Bowles, Professor
Consolidation of Individuality and Emotional Constancy
The fourth sub-phase of separation individuation, which begins toward the end of
the second year is open-ended. During this period, a degree of object constancy is
achieved, and the separation of self and object representation is sufficiently
established. Mother is clearly perceived as a separate person in the outside world,
and at the same time has an existence in the internal representational world of the
child.
Emotional Refueling
During the practicing and rapprochement sub-phases, the infant moves away from
the mother, but when s/he becomes fatigued or depleted of energy, s/he seeks to reestablish bodily contact with her. This “refueling” perks the toddler up and restores
his/her previous momentum to practice and explore.
Mutual Cueing
A circular process of interaction established very early between mother and infant by
which they “empathically” read each other’s signs and signals and react to each other.
For example, the mother learns the meanings of the baby’s different cries and
movements: the baby learns to anticipate the mother’s ministrations: s/he also
learns soon which cues the mother (unconsciously) picks up and which she does not.
No mother perfectly responds to a baby’s cues, but serious mismatching of cues is an
obstacle in the path of smooth development.
Shadowing and Darting Away
During the rapprochement sub-phase, the child, at times, follows his/her mother’s
every move (“shadows” her); s/he cannot let the mother out of sight or out of his/her
vicinity. At times, we observe the opposite behavior, the child darts away, and waits
for and expects the mother to swoop him/her up in the mother’s arms and thus for
brief moments undo the “separateness”.
Ambivalence
Ambivalence can occur only when there is representation of a single, whole person.
Separation/Individuation has to have occurred at least in its beginning stage. The
person can tolerate mixed feelings occurring at the same time; can tolerate good and
bad feelings being present in the same person.
219
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