ADULT ASSESSMENT AND TREATMENT
ADULT ASSESSMENT AND TREATMENT SW 700
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This 10 page Class Notes was uploaded by Irma Brekke on Friday October 23, 2015. The Class Notes belongs to SW 700 at University of Kentucky taught by Carla Van Hoose in Fall. Since its upload, it has received 12 views. For similar materials see /class/228164/sw-700-university-of-kentucky in Social Work at University of Kentucky.
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Date Created: 10/23/15
Cognitive Therapies SW 700 April 11 2006 Albert Ellis Rational Emotive Therapy Does NOT believe that unconscious conflicts are responsible for neurotic symptoms Problems due to irrational philosophy of life Goal of therapy attack client s belief system Push clients to work AGAINST their own irrational premises Therapist very directive Convince clients to use their IRRATIONAL mind to maximize pleasure and minimize pain REBT Theory of Personality ABC Concept A Activating events of life ie rejection failure B Beliefs used to process activating events can be irrational iB or rational rB C Conseguences person experiences emotional and behavioral consequences of whatjust occurred ABC Concept Beliefs more important than activating events Individuals make themselves emotionally healthy or unhealthy by the way they think NOT their environment No valid reason to make ourselves emotionally disturbed Life not fair learn to tolerate discomfort including sorrow regret displeasure Theory of Psychopathology Individuals differ in inherent tendencies to think irrationally 12 common irrational beliefs that create emotional upset Commonly beliefs reflect demanding and absolute mode of thinking Beliefs have two main qualities Rigid dogmatic powerful demands at their core They catastrophize are selfdisturbing and generate highly unrealistic attributions Theory of Therapeutic Process Can t focus on A or C Path to positive change in modifying B D Disputing irrational beliefs E form Effective new philosophy 1 Identify iB that are causing symptoms 2 Dispute them vigorously 3 Replace them with rB How to Change iBeliefs Ask clients to provide evidence for maladaptive beliefs Provide homework based in logic Use behavioral techniques Interpretation make connections between present complaints and current beliefs clients are using to upset themselves Refutations point out contradictions between Beliefs n actions ncourage expression of emotion to underscore consequences of iB Counterconditioning encourage engagement in healthy behaviors tp counter unhealthy Therapeutic Process cont d Problems are intrapersonal vs intrapsyc ic Clients frequently placed in groups where they get support for iB Anxiety result of irrational cognitions Defense mechanisms examples of irrational human propensities defenses are not challenged but protected The Therapeutic Relationship Opposite of personcentered therapy Evaluate client s beliefs and behaviors don t bother trying to like the client REBT therapists reveal their OWN ideas beliefs and behaviors Transference challenged not encouraged too irrational BECK s Cognitive Therapy Discovered from teaching patients to examine and test their negative beliefs helped their depression improve Developed several instruments Beck Depression Inventory Beck Anxiety Inventory Scale for Suicide ldeation Cognitive Therapy Instead of focusing on irrational beliefs focus on Maladaptive cognitions Dysfunctional attitudes Depressogenic assumptions Some overlap with Ellis Irrational Beliefs Cognitive Errors cause Depressmn Overgeneralization true in one true in another Selective abstraction only failures matter Excessive responsibility sole responsibility for bad things Selfreferences I at center of everything Dichotomous thinking Eitheror no in between Theory of Psychopathology Each disorder has specific cognitive content Depression has three themes Events are interpreted negatively Depressed individuals dislike themselves Future is appraised negatively Theory of Therapeutic Process Therapy about ferreting out automatic thinking then reevaluating and testing for logic and empirical evidence Clients pass through phases as they correct faulty cognitions Becomes aware of hisherthinking Recognizes which thoughts are awry Substitutes accurate for inaccurate judgments Gets feedback to inform whether changes are correct Cognitive therapist will administer brie checklists to monitor patient s condition and Treatment goals are sequenced Use cognitive Choose daily activities based on how they elevate mood Therapeutic Process Reduce severe symptoms ie Structure assignments so that 5 clients succeed and are reinforced by their effort restructuring evidence vvhat s anotherwayto loo at lt7 So what if it happens esp helpful With ahwety related to OCD traits Therapeutic Process Techniques Distancing Learn to deal with upsetting thoughts by reevaluating them instead of accepting them Disattribution Remove the beliefthat they are entirely responsible fortheir plight ASif Encourage client to think ofhimself as ifquot her were successful Therapeutic Relationship Use tactful progression of questions Clients and therapists on shared mission to determine evidence about which thoughts may be dysfunctional Homework is a mutual decision in which patient is asked to test logic of their cognition Practicalities of Cognitive Therapies REBT short term and for mildly disturbed individuals Cognitive therapies good for neurotic disorders anxiety an epression Frequently blended in to other therapies is supportive relationship focused Insurance companies like bc brief and measurable Effect sizes magnitude of change higher when therapists were experienced and with longer treatment imes Initial analyses suggest superiority of cognitive techniques until remove investigator allegiance bias Practicalities cont d Depression Trx of choice Anxiety Out perform 5 medication Psychotic disorders Meds and GET better than meds and supportive therapy Eating disorders Trx of choice Marital problems No better than anything I Criticisms f central assumption that disorders are fct of belief about events how does abuse trauma other environmental issues factor in REBT simply replaces irrational demands of parental superego with demands of an attacking authoritative clinician who teaches submiss39ve patients to accept questionable philosophy of life Assumes that rational mind is be all and end all what about the supernatural spiritual emotional etc that tend to be less rational What about THER ways of knowing Goal NegotiationMusts Must have contextual andor situational features Must be described as including the presence of some behavior andor art of something rather than the absence of some behavior Must be small rather than lar e Must be salient to client and therapist Must be described in speci c concrete behavioral terms Must be realistic and achievable Must be perceived by client as involving hard work on hisher part Goal Negotiation Examples What makes you think you need to come here What do you think is the reason you have this problem What would ou say minimally you need to do different When was the last time you did this How did you do this What was help Jl in getting you started What is the rst step you need to get started How con dent are you that you can do this again What would it take foryou to raise your con dence a bit what would you say the chances are that you will do is What do you suppose others will notice different about you when you do this Solution Focused Questions Miracle question Exception question 7 i rn dstvydndering on i Scaling questi are tnere tirnes When tnis prdbiern ddesn t new 7 On a scale rrdrn i e iuvyitn in meaning ydd naye eyery ednridenee tnis prdbiern can be sdiyed and i meaning no ednridenee at all Where between i and in Wudid ydd piaee yddrseir tdday7 Coping question 7 Huvv du ydd edpe huvv du ydd getthruugh tne day ete Relapsdsetbacks Huvv did ya manage td stop when ydd did7 Ask about posi ive chan es at is better abuut tnis WEEK ys Huvv Was yddr Weew Amplify Details about positive changes When did tnis nappen7 Tnen vynat7 Whu eise rimmed Elicit e W Edeetieiimeumwe ExistmuzHummisne caunseinrs 1 a a Choosing the Best Psychotherapy Intervention Everyone has won and all must have prizes Do Bird from Alice in Wonderland Most use interpretation catharsis therapist s personality Successful psychotherapy contains similar important elements support interpretation insight behavior change good therapeutic relationsh39p MOST IMPORTANT clients positive expectations and facilitative therapeutic relationship Process of Change Consciousness raising Catharsis Choosing Conditional Stimuli Changing responses counterconditioning Changing environment stimulus control Contingency Control If reinforcement contingent on response will make se If punishment made contingent less likely to emit What is the CONTENT of Psychotherapy WHO is involved Intrapersonal con icts Individuosocial con icts Individual Individuals families Anxieties and defenses roups Selfesteem problems Adjustment vs e onal Responsibility transcendence Interpersonal con icts Impulse rftr l gindividuals couples 39 fBu IEf mgn ion 39dm am Ies Intimacy and sexuality Ind39V39dlj39al Communication Meafllng Iquot f9 Hostim The Ideal person Control of others What is the PROCESS of Psychotherapy Psychoanalytic Unconscious to Cognitive consciousness S t Examine Irrational ys emquot and maladaptive Gender and Culture beliefs sens39t39Ve Examine group and family dynamics communication structure rules Examine perception of social positionality Choosing Based on content or process What you bring to the room Get specialized training in method that resonates with you
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