Chapter 2:
Theoretical
Perspective on
Direct Practice
An Overview
1
Direct Practice
Unrealistic to teach all models (250+) so will
present select models to assist in creating a
knowledge base for each student.
Focus is on using deductive models from a
broad prospective moving toward specific
theories, models and techniques.
2
Copyright © Allyn & Bacon 2006
Direct Practice Skills
► Know
how to develop & maintain professional
helping relationships
► Collect
& assess information about the
problem/situation
► Recognize
► Develop
► Use
the client’s strengths and abilities
a plan to improve the problem/situation
proven research interventions
► Work
within NASW values & ethics
Copyright © Allyn & Bacon 2006
3
Direct Practice Effectiveness
► Average
client 80% better than those not
treated at the end of treatment (Smith et.al.
1980)
► Average
client showed 75% improvement
after 6 months of weekly psychotherapy
(Howard, et.al. 1986)
► Medical
model grew out of Freudian theory
of psychodynamics
Copyright © Allyn & Bacon 2006
4
Common Elements of Effective
Practice
►
General areas of improvement include extra therapeutic
change, therapeutic relationship, techniques, and
expectancy-placebo effect (Asay & Lambert 1999)
►
Findings suggest therapy is a viable treatment for
psychological disorders
►
Theories, models, and techniques do not differ
significantly in terms of positive outcomes
►
For some disorders specific techniques produce better
outcomes
►
Long-term therapy is not necessary to produce
improvement
Copyright © Allyn & Bacon 2006
5
Theories & Models
►A
theory is “a group of related hypotheses,
concepts, and constructs, based on facts and
observations, that attempts to explain a particular
phenomenon (Baker 1999)
► Theories
are then conceptualized as models which
are mapped out representations of relationships,
concepts, and constructs
► Professional
“joins” with the client by applying
theoretical knowledge,assessing biopsychosocialcultural conditions, and client’s strengths and
resources to ameliorate the identified problem
Copyright © Allyn & Bacon 2006
6
Five Domains for Understanding
Human Behavior
► Biological/physiological
► Psychological
► Emotional
► Behavioral
► Environmental
Copyright © Allyn & Bacon 2006
7
Domain Selection based on
influences
► The
time practitioner received education
► Practitioners
personality, values, and sense
of which models match personal style and
belief system
► Influence
of a mentor or significant person
Copyright © Allyn & Bacon 2006
8
An Integrative Model
► Practitioner
learns a variety of theories and
techniques for assessment, implementation
and interventions
► Eclecticism
► Selective
borrowing
► Specifically
Copyright © Allyn & Bacon 2006
designed integrative models
9
Strengths vs. Problem
Perspectives
► Medical
model referred to as problem, disease or
deficit model (uses diagnostic code often DSM to
identify problem)
► Social
Work profession has moved toward a
strengths oriented focus
► Everything
you do as a social worker will be
predicated in some way on helping discover and
embellish, explore and exploit clients’ strengths
and resources” (Saleebey, 2002)
Copyright © Allyn & Bacon 2006
10
Biological-Genetic/Neurological
Theory
► Personality
and psychological disorders
► Temperament
► Activity
► Family
& traits
level, sociability, & emotionality
history (e.g. alcoholism)
► Neurochemistry
Copyright © Allyn & Bacon 2006
11
Ego Psychology
►
Emphasis on sociocultural factors, interpersonal
relationships, and psycho-social development through life
►
Object relations emphasis on caretaker relationship early in
life
►
Self psychology focus on how people view self and parents
►
Energy derived from desire to adapt to objective external
reality
►
Built on belief that people learn how to cope with, adapt to
and shape the world around them
Copyright © Allyn & Bacon 2006
12
Ego Psych (cont’d)
►
Important biopsychosocial factors are heredity and
environmental impact
►
Ego development requires mastery of developmental tasks
sequentially
►
Ego is autonomous and relates to internal drives and needs
►
Ego mediates internal conflicts & drives, environment &
person
►
Personality is shaped by social environment
►
Problems with social functioning require the evaluation of
individual’s environmental resources and conditions
(Goldstein 1995)
Copyright © Allyn & Bacon 2006
13
Cognitive Therapy
► Cognition
is knowing through insight and
understanding experience
► Knowing
through “cognitive maps” which organize
& learn (Tolman & Honzik 1930)
► People
take in information, process it, and then
develop a plan
► Incorrect
processing comes from arbitrary
inference, selective abstraction, overgeneralization,
minimalization, personalization, and absolutistic,
dichotomous thinking
Copyright © Allyn & Bacon 2006
14
Behavioral Therapy
► Focus
on exhibited maladaptive behavior
► Classical
conditioning
► Operant
conditioning
► Social
Learning includes behavior, environmental
influences and reciprocal determinism (Ewen
2003)
Copyright © Allyn & Bacon 2006
15
Copyright © Allyn & Bacon 2006
16
Copyright © Allyn & Bacon 2006
17
Person Centered Theory
► Individual
basically sound, whole, healthy, and
unique with an innate drive for growth and selfactualization (Maslow 1968)
► Each
person’s experience is unique and subjective
► Emphasize
therapist
relationship between client and
► Focus
toward self-fulfillment, self-actualization and
wholeness
► Treatment
► Emphasis
depends on client insight
on free will and choice
Copyright © Allyn & Bacon 2006
18
General System Theory
►
Focus on the whole including behavior and societies interacting
between systems with controls to stabilize and maintain a state
of equilibrium (Baker 1999)
►
A system includes the “whole” and all related parts and
processes
►
Issues include boundaries, subsystems, roles and maintaining
homeostasis
►
Inputs and outputs provide positive and negative feedback
►
Interface happens at the point two or more systems intersect
►
Differentiation, entropy and negative entropy identify how
system moves from simple to complex
Copyright © Allyn & Bacon 2006
19
Multicultural Theory
► Worldviews
are the reservoirs for our
attitudes, values, opinions and concepts and
influence how we think, make decisions,
behave and define events (Sue et.al. 1996)
► Worldviews
are influenced by culture
► Practitioner
must be aware of client culture
to ensure supportive services
Copyright © Allyn & Bacon 2006
20
Multicultural Counseling Therapy
(MCT) (Sue et.al. 1996)
► Therapy
is tied to culture and beliefs
► Counseling
theory automatically favors that culture
► Practitioners
worldview influences how client’s
concern is defined
► MCT
incorporates and combines elements
► MCT
attempts to assist clients in generating new
ways of feeling, thinking and acting
► MCT
is a theory of predicting failure from
overemphasizing cultural differences or similarities
Copyright © Allyn & Bacon 2006
21
MCT (con’t)
► All
people have multiple levels of identity
► Identity
is influenced by person’s context
► Client’s
will notice similarities and differences with
social worker & uniqueness
► Client
concerns usually include culture
► Social
worker has own worldview
► Social
worker must be skilled and knowledgeable
to be able to track the client
Copyright © Allyn & Bacon 2006
22
MCT (con’t)
► Both
client and practitioner experience a
cultural identity
► Developmental
processes and cultural
identity influence one’s self identity
► Goal
setting is likely to be influenced by
cultural development and identity
Copyright © Allyn & Bacon 2006
23
Counseling Culturally Different
► Cognitive,
emotional and behavioral aspects of an
individual follow a sequence
► Each
client has multiple cultural identities
► MCT
may help client’s recognize cultural issues
► Important
to see self-concept as “conception of
self-in-relation”
► Social
worker must be aware of power differential’
► Social
worker must continually strive to increase
awareness
Copyright © Allyn & Bacon 2006
24
Cultural Difference (con’t)
► Acknowledge
development
► Behavior
context
► Identity
must be assessed through cultural
is complex
► Disagreement
► Need
the contextual factors of cultural
is often difference
to be flexible
► Cultural
difference is not equal to individual
difference
Copyright © Allyn & Bacon 2006
25
Cultural Difference (con’t)
► Intentional
and unintentional racism are harmful
► Culturally sensitive approaches include universal
and culturally specific
► Use a cultural frame of reference
► Counseling and psychotherapy are based on
language
► Client and counselor matching should be the
client’s domain
► Social workers need a variety of skills including
empathy and appropriate response
Copyright © Allyn & Bacon 2006
26
Cultural Difference (con’t)
► Help
is best when the social worker can
apply numerous roles (therapist, broker,
mediator, case manager, advocate) across
micro, mezzo and macro levels
► Network
► Be
with others
open and flexible
► View
counseling in broad terms using title
based on client positive connotation
Copyright © Allyn & Bacon 2006
27
Cultural Difference (con’t)
► Values
and ethics may need to be reframed to be
culturally sensitive
► Each
client occurs in a cultural context
► Successful
outcomes based on individual-incontext model
► Multicultural
accuracy
Copyright © Allyn & Bacon 2006
assessment perspectives increases
28