The PAB-technique = social workinstrument in multiproblem cases
Stockholm
2012
Herman de Mönnink, Netherlands
www.mmsocialwork
Herman de Mönnink
-
35 years Instructor School of Social Work
Social Workers’ Toolbox (2004)
Trauma-psychologist & grieftherapist in pp
Founder Study of Loss in NL (book 2010)
Unfinished Business Syndroom (UBS)
www.mmsocialwork.com
Overview presentation
•
•
•
•
•
•
Question
Assumptions theory SW-methods
Casestudy Mrs. Multiplex (39)
Definition PAB
Results PAB + other interventions
Conclusion
Question
How can you as SW’er use
the PAB-technique
in multiproblemclient-situations?
Case Mrs. Multiplex (39)
• Referred
by general doctor
• Will be thrown out of her home
• Social service blocked
• No overview in income/administration/
• She does not react on calls
• Serious debts
• She is isolating from home and family
• Was treated by psychologist - depression
• 1 ½ years ago her son (19) died
• Intelligent woman
1 Social Work-goals
Stressreduction
&
empowerment
on all levels
2
In life
you must
do it yourself
but not alone
-individual
-systemic
-macro
Empowerment
www.mmsocialwork.coml
Social work symbol?
Stressors ----
Personal
strenghts
Social
strengths
3 Bio-psycho-social
stressors vs strengths
•Individual-interpersonal-macro cycles.
iSET: integrated
Stressreduction & Empowerment Theory
+ Strenghts
5 Clientfactors
1. Life-events
2. Condition
3. Coping
4. Social
interaction
5.
Environment
- Stressors
Multi-stressors = multi-method
Individual stressors > 9 individual methods
problemstress, existential -, cognitive -,
emotional -, practical -, behavioral -,
trauma-, grief-stressors
Interpersonal stressors >
7 systemic methods
Macrostressors > 4 macro-methods
SW-approach =
always clientcentered
Clientcentered =
start, follow and end where the client is
Mrs. Multiplex: multiproblem & complex,
where to start and where to end?

Finance?
Institutions/procedures?
Health ?
Relation spouse?
No Income
Cooperation
with
institutes
In ‘war’ with
institutes
Psychosomatic complaints
Bad relation with spouse
Growing up children?
Social network?
No trust in others
Laws and services?
Traumatic incidents?
Psychological problems?
Strong tensions/emotions of son-loss
Depressed
Violence?
Debts?
Housing?
In
debts-arrangement
Serious
debts
Threaths of losing her house
Case management ?
Insights?
No insight of relation son-loss and multi-problems
SW approach
in 3 steps
•1. PAB (Personal Archive Box)
•2. PSA (Psychosocial Stress Analysis)
•3. PST (Psychosocial StressTreatment)
Step1 PAB: Personal Archive Box
• Again: Start-follow and end where the
client is!!!!!!!!!!!!!!!!!!!!!!!
• Making contact and hearing clientstory
• Summarise and visualise in PAB
Definition PAB
Visualizing
the clientstory
by drawing the client and
mark all stressors
with minus (-) and
all strenghts
with plusses (+)
in-words-of-the-client.
Step 1. PAB = Personal Archive Box
Mrs.
Multiplex
- My son (19)
died 3 years ago
- Help: I loose my
house…
-I close myself
- I do not speak
with my spouse
- I do not share
my grief
- I have grief and
anger-attacks
- Serious debts
--Refuses to
accept rules of
social service
+ Would like to
have help from
SW
- Miss my son
-- Psych did not
help effectively
+ I feel a strong
woman
+ Supported by
my friend
+ I am physically
healthy
+ Supported by
general doctor
Step 2: PSA PsychoSocial Stress Analysis
Individual &
Social
Strenghts?
+
strenghts
stressors
Individual &
Social
Stressors
-.
PSA Mrs. Multiplex : unhealthy balance?
strenghts (+)
vs
stressors (-)
•Individual strenghts
+ phyically health
+ Intelligent woman
+ Looks for SW-help
Social strengths
+ Support by daughter + friend
+ Effective refer-system
from general doctors to social work
strenghts
Individual &
social Stressors
-Son died
-Depths
stressors
-No income
-Threath of eviction
-No energy
-Depressed
- Grief and anger
-Discommunication with spouse,
-No family-support and network
-Strict rules and conditions social service dpt.
3. PST: PsychoSocial StressTreatment
working together for healthy balance
Reduce
individual &
social
stressors
stressors
strenghts
Empower
Individual &
social
strenghts
Scaling: stressmonitor
10 = I experience maximum of stress
10
9
x
x
8
x
7
x
6
5
x
x
4
x
3
x
2
x
x
9
10
1
0
1
2
1 = I feel totally relaxed
3
4
5
6
Monitoring
7
8
Scaling: empowerment monitor
10 = I can help myself
10
9
8
x
7
6
x
8
9
x
5
x
4
x
x
3
2
x
x
x
x
1
0
1
2
3
1 = I cannot manage myself
4
5
6
Monitoring
7
10
Progress Mrs. Multiplex by PAB
clientcentered multimethod social work

Finance?
Mediation?
Health care?
Relation spouses?
Income is ok
Cooperation
with institutes
More in cooperation
with institutes
Reduction psychosomatic complaints
Attachment with spouse improved
Grown up children?
Social network?
Getting more trust
Laws and services?
Traumatic incidents?
Psychological problems?
Releases tensions/emotions of son-loss
Not depressed anymore
Violence?
Debts?
Housing?
In
Is debts-arrangement
in debts-arrangement
No threath of losing her house
Case management ?
Insights?
More insight of relation son-loss and multi-problems
PAB helps clients
ordering, cleaning and
clearing not only the real
home but also the inner
client-home
•Questions?
Contra-indications PAB




Urgent crisis (client urgently needs crisisintervention)
Client is physically and emotionally too weak
Insufficient cognitive functioning
Simple question/problem: no need for collection by PAB
PAB-technique: advantages?
+ Collecting & improving consciousness
+ Prioritize: stressors & strengths overview, no tunnelvision
+ Clarity about tasks to be done by the client and by the
social worker
+ Client gets/holds direction in social work-contact + cl.life
+ Helps focussing: what is actual & old unfinished business
+ Monitoring progress: effective SW-approach with this cl.?
Step 2: PSA Mrs. Multiplex (39)
+ Strenghts
5 Clientfactors
1. Life-events
+ Physicall healthy
+ Strong woman
2. Condition
- Stressors
- Death of son
-- Losing her home/electricity
-- Income
--
Depressed
+ Would like help of SW
3. Coping
- Coping with depths
-- Coping with grief and anger
-- Refuses social service
propositions
+ Support daughter (21)
friend
4. Social
interaction
- I isolate myself from spouse,
parents, others
- Bad communication with
spouse
+ Effective referrals
general doctor to general
social work
5. Services
Social program is very strict in
conditions and rules
- Psychopathologizing psychs
-
Psychosocial Stress Treatment (PST)
Mrs. Multiplex
•Reduce inadequate coping with institutes
•Mrs. Multiplex is not obeying the rules
•Mrs M. reacts with anger on officials who threaten her with
homelessness, cutting her off electricity
•Practical materialistic method
•Goal:
•Techniques:
reduce stressors by helping
practically with housing and
materialistic problems .
Informing, referrals, advocay, mediate,
concrete help.
PST Mrs. Multiplex
• Reduce inadequate problem-coping and
existential coping
• Don’t know no what to do with my life……..so start a war
against
Non-directive counseling-SW-method
• Goal:
making time for dealing with
the loss of her son and making up
balance in questions like ‘why did this
happen to me’?
• Technique:
counseling to establish a working
relation
PST Mrs. Multiplex
•Reduce unrealistic cognitive coping
• I will not share my grief, because they will not listen
•Cognitive SW-method
•Goal:
unrealistic, negative, harmful thoughts of
Mrs. M. about herself and the world are
influenced to a realistic direction
•Technique: challenging-technique
PST Mrs. Multiplex
• Reduce inadequate behavorial coping
• I am pissed off when one is frustrating me
• Behavior SW-method
• Goal:
learn assertive skills (not aggresive)
• Technique:
social-skill-training
PST Mrs. Multiplex
•Reduce inadequate social interaction
•Mrs. M. is very unhappy and angry and destructive after
losing her son.
•Refuses support and contact with family and network
•Refuses to share her grief with spouse and others
•Couple- and network-SW-method
•Goal:
attach to spous and others in sharing grief
and solving communication problems
•Technique: communication and LSE (Listen Summarize Empathy)
PST Mrs. Multiplex
• Reduce inadequate Services
• Rules are too strictly for crisisclients
• Psychopathologing depressed clients
• Macro-SW-methods
• Goal:
structural improvement of cooperation
between social services and clients;
normalizing clients wityh grief
• Techniek: class advocasy and articles
PST Mrs. Multiplex
•Reducing emotional stress losing her son
•Mrs. M. is building up inside: grief, anger after losing her child
•Non- directive counseling, discharge-method & ritualmethod
Goals:
hearing the clientstory and ackknowledge the
tragedy and help her to discharge her
feelings, and finish the emotional unfinished
business
•Techniques: safetytechnique, miror-technique,
say-goodbye-technique