ADULT ASSESSMENT AND TREATMENT
ADULT ASSESSMENT AND TREATMENT SW 700
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This 18 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 Staff in Fall. Since its upload, it has received 15 views. For similar materials see /class/228168/sw-700-university-of-kentucky in Social Work at University of Kentucky.
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Date Created: 10/23/15
Systemic Gender and Culture Sensitive Therapies SW 700 2009 Systemic Therapies Systems theory Review of terminology Who is the patient Three major approaches CommunicationsStrategic Structural Bowen Family Sytems CommunicationStrategic Therapy All behavior is communication Theory of Psychopathology Interactional process between family members Function of unclear or hostile communication Symptoms serve as negative feedback loop Trade off with changes in symptoms Breakdown result of ambiguous rules of relating Often find double bind communications CommunicationsStrategic Theory of Therapeutic Processes Goal to help individuals in system communicate more clear Emphasis on relationshipdefining aspects and NOT on content of communication Try to make family members aware of dysfunctional communication Pay attention to metacommunication Recognize that family systems resistent to change CommunicationsStrategic Therapeutic Relationship Don t be blinded by content ofcommunication Learn who communicates what and to whom Re 39ame family rules Prescribe the symptom paradoxical intervention Create therapeutic double blind where behavior becomes a choice ratherthan symptom Therapist is active directive Emphasis on accurate empathy positive regard and genuineness Structural Therapy Minucchin Theory of Psychopathology Concerned with what maintains psychopathology than with its causes What can be changed is what maintains it Psychopathology maintained by interpersonal dynamics in system Rules that govern transactions within family form a whole the structure for the famin To change structure change rules Structural Therapy Types of family structures that need changing Disengaged rigid boundaries distanced Enmeshed diffuse boundaries not respected Dysfunctional families respond to change in pathological ways Healthy families respond by attending to each individual One family member develops symptoms and becomes the identified patient even tho family as whole needs to change Structural Therapy Theory of Therapeutic Process Goal to restructure family to free members to grow an relate Do so by changing rules Change from rigid to diffuse to normal from disengaged to ealthy Therapist is active and directive Joins the system to change from within become authoritative May ask family to enact family transactions rather than describ Emphasis on soci al liberation Begin with contra t c Bowen Family Systems Theory of psychopatholo y Result of people not being able to differentiate themselves 39om families oforigin Lack of boundaries fusion interferes with differentiation Fusion leads to triangulation enlisting others in a ispute Emotional cutoff used to deny or isolate from unresolved attachments to family Family projection process pulls family together by creating preoccupation with child s problem Dysfunction transmitted across generations Bowen Family Systems Theory of Therapeutic Process Goal to increase differentiation of self from family Triangles interfere with differentiation attempt to de triangulate Change produced in one triangle produces change in others Bowen focused on couple wo children Patients asked to observe what the other is communicating Bowen Family Systems Therapist is active with constant questions 5 others what they ve heard Use genograms to teach about dysfunction Emphasis on observation ratherthan interpretations Predictable steps ong change back lfyou don t you will be criticized or ostracized Don t allow yourself therapist to become triangulated Act as model of autonomy with responsible and differentiated behavior Systemic Therapies Designed to be short term Brief therapy 10 sessions Focused on problem solving not changing system Individual therapy for marital problems ineffective Family therapy effective for Substance use motivating users to enter treatment to supplement medication therapy for those with schizop renia Overall very LITTLE evidence on effectiveness ssumes existence of single normal famin regardless of race class culture gender etc Gender and Culture Sensitive Therapies Psychotherapy created by white European men e in their own 39ma lnescapably bound to its cultural framework Traditional therapies increasingly inappropriate or ethnic minority and other oppressed groups Psychotherapy must adapt as population ecomes more 39 Two perspectives Develop psychotherapies for each grou velop crossgender crosscultural therapeutic skills that apply to wide variety of groups Feminist Therapy Theory of personality Identity based in part on environmental pressures like gender discrimination This in uences cognitive structures and behavior patterns Power inequalities shape cognitive structures of e child Girls and boys socialized differently Genderrole expectations deeply ingrained in the personality Feminist Therapy Theory of psychopathology Women share characteristics of other oppressed people Healthy women recognize negative effects of maledominated society on women s self concepts Psychological distress environmentally induced and culturally determined Pathology occurs when social structure so rigidly defined people can t grow within it Feminist Therapy Distress not solely intrapsychic but social and political Gender socialization shapes expression of distress Genderrole conflicts generate a false sense of self Women forced to accept gender rules which can create anger frustration resentment overtime Society hampers women s success Feminist Therapy Key Concepts Role strain Role conflict Mother blaming Glass ceiling 1 women experienced some form of childhood sexual abuse Women are then victimized later by society Women at economic disadvantage Feminist Therapy Women s problems not necessarily pathological but rather an attempt to survive oppressive condIt ons Anxiety natural reaction to forces of sexism discrimina on Problems with intimacy come from being seen as sexual objects Problems with communication come from men women n talking the same language Control is central issue women internalize lack of control Feminist Therapy Theory of therapeutic process Consciousness raising vital Goal to teach women to differentiate between what they have been taught sociall Examine your own practice and language for gender stereo ypes Techniques Power analysis groups Sex role analysis groups Consciousness raising groups Bibliotherapy Encourage women to become involved in political process Therapy combines personal internal and political external Feminist Therapy Therapeutic Relationship 7 E Werrnent r Egalitarianisrn Women entitled to power Reduce knowledge discrepancy erate m tual goals Increase clinician s selfdisclosure Demystify process oftherapy Avoidjargon onsumer oriented encourage clients to shop around for righttherapist Can male therapists practice feminist therapy Psychotherapy with Men Men are negatively affected by gender role expectations Four stereotypes of masculinity No sissy stuff should avoid feminine things The big wheel should be success Jl The sturdy oak should be con dent strong and self reliant Give em hell should be aggressive and daring Society inhibits emotional expression and intimacy in men Culture Sensitive Therapy Theory of personality Culture determines personality Each culture includes norms events expectations that shape the individual No universal theory of personality Personality characteristics differ among racialethnic groups Culture Sensitive Therapy Theory of psychopathology Many culturebound syndromes Psychopathology can be the result of Discrimination Inadequate coping methods Societal expectations Economic hardships Nonnatives of dominant culture face problems with language customs gender social roles etc Culture Sensitive Therapy Acculturation issues May cause intergenerational conflicts Decision about whether or not to maintain bi or multicultural identity Culture Sensitive Therapy Model of racialcultural identity development Con ormity values dominant culture Dissonance con ict between appreciationdepreciation Resistance and Immersion deprecia ion toward dominant culture lntrospection concern about basis of attitudes Integrative Awarenes s learns to appreciate themselves their group and other s Culture Sensitive Therapy Theory oftherapeutic process Goal to get patient to understand how dominant culture has shaped their views about themselves Clients must understand effects of prejudice Therapists help clients express feelings work through antagonism and redirect anger Anxiety about cultural norms at root of client s distress Culture Sensitive Therapy Therapist s tasks Therapists must come to terms with and understand their own feelings about racism and a client s culture Learn as much as you can about clients culture Help clients achieve a bicultural identity Culture Sensitive Therapy White reviewers tend to minimize effects of ethnic differences Racialethnic minorities emphasize findings in which differences are found Evidence suggests preferences for ethnically similartherapists but little evidence that outcomes differ for better or worse February 28 2006 Agenda Return Quizzes Suicide Stats Chapter 8 Shea Assessing Lethality and supplemental material 10 minute case study Pomeroy ch 5 Study Guide for MidTerm 3706 Will cover Treatment Planning Mental Status Lethality Shea 4 8 9 supplemental material Assessing Lethality SW 700 February 28 2006 Available Suicide Stats 2003 wwwsuicidologyorg 11m Leading Cause of Death in US 108 National Rate suicidespopulation x 100000 Highest risk groups Males White 195 Native American 104 an A rican American 88 in particular Elderly 65 146 Young 1524 97 Eachlsuicide intimately effects at least 6 other Op 6 What s Suicidal Person May Feel or Experience Can t Can t Stop he pain Sleep eat or work Feel anything Get someone s attention Get rid ofvoices that tell Seem to get control them to kill themselves cope with overwhelming Make decisions anxiet See a way out Imagine living without Stop fee ngs of whatever was lost hopelessness Live with the See a future without the quote quotes 395 Ia i0quot pain ive like thisquot whatever See self as worthwhile this is Connecting with Client s FeeHngs From Depression to Suicide Continuum of negative thought patterns Thoughts that leadtu Selfrdepreclatlrlg Luvv selfees teem ur lerardrlESS Ratienalizing se federllal selfedefeatlrlg thoughts Cynlcal attltudes toward uthErS Thoughts lnfluenclng lsulatlurl Selfecurltempt mgmsma Wm Thoughts uslrlg use er substances Or fund followed by SEl ErltlElSm DEPRES l N SUlClDE Cuntrlbute El sense er helplessness influence a Ersurl El gve up prlurltles ngmmat lead m 5mm lnlunctluns El lnfllct selfeharm self anmm amg Mam F39larlrllrlg detalls lnlunetluns to Carry out plans Gumquot mm mm Three Key Components of Completed Suicide How exactly does one acquire the ability to enact suicide What are the constituents of the desire for suicide 1 Acquired capability to enact selfinjury 2 Perceived burdensomeness 3 Thwarted belongingness Model suggests that prevention can happen if process interrupted Through therapy the perceptions can change ONCE this occurs it is yery dlfflcult to get rid of F39Ercelved Elurdensorneness 39 Elelurlglrlgrless Therapy is especially Those who are capaple or suicide hopetul here Serious attempt or death by suicide Indicators of Lethality Being male elderl Thought disordered ps chosis specifically 7 command hallucinations teelings otalien control religious preoccupation e Schlzuphrenla more llkely responding to demoralization and depression other psychiatric disorders 7 DEprEsslun Upun improyernehtlliii 7 chronic alcohol and drug use lmpulse control is lowered lnadyertent suicide may occur due to impairment 7 Borderline Personality Disorders 7 tarnily disruption Risk factors cont d Previous attem ts Also family history of suicidemodeled behavior Specific plan when how where Readily available means In hand auto hanging jumping explosive gun Isolation and rejection Poor support system No friends Friends a ailable but unwilling to intervene Risk Factors cont d Recent losses Especially loss of spouse Never married divorced widowed Immediate period following discharge from hospital first month Personality types Controlling Dependentdissatisfied symbiotic relationships Hopelessness Chronic versus Immediate risk Chronic Variety of risk factors present over time Immediate Previous attempt s Psychosis Statement of intent Assessment of lethality Weigh risk factors Examine historical elements Gather information from the interview ALWAYS ask directly about intent Myth that you will plant the idea Patients may be hesitant to discuss since many understand implications Setting Platform for Suicide Inquiry Pt must feel safe AND be in touch with their own pain Lead up to the questions after empathic bond established Don tomit questions Ensure that your interview style does not lead pt to provide misleading responses Certain environments might foster non thorough assessment Steps in Lethality Assessment Chronological Assessment of Suicide Events Explore presenting suicidal events How close did pt come to dying by suicide How does the pt feel about NOT dying Ask to be walked through event in detail Explore recent suicidal events What plans had been made How far did pt get with plans How much time was spent on plans Steps in Lethality Assessment Explore m suicidal events Most serious past attempt Number of attempts in past Recency of past attempts Explore immediate suicidal events Where is pt right now re intent Safety contracts Assessment and Management of the Suicidal Patient See handout John the Social Worker Duty to Warn Tarasoftys Regents or University ofCaliforriia r Grad student Pruseriiit F39uddar dated felluvy student Tatiana Tarasuff r lridiari student unfamiliarvyith American sucial nurms and felt kisses shared indicated strunger relatiunship than What Ms Tarasuff bEllEVEd 7 Revealed his iritErittEI psychulugisttu getgun and shunt Ms Tarasuff 7 Dr seht ietterte earhpus pehee requesting they take hirh te psyeh Huspital 7 Puddar was released arter being interviewed by campus pbhee whb were ebhwheeu that he was hbt dangeruus Nu rurther arm was taken and the ietterrrbrh psychulugist was urdered destruyed 0 er s mmEr Puddar mDVEd h With Tarasuff s bruthervvhile Tarasuff was vacatiuning Upuri her return Puddarstalked herahu stabbed her tEI death Tarasorrs parehts sued campus police u Health Services and Regents oru orCaiirorhia There had been ho statute on duty to warn a third partyl Homicidal ldeation Three domains of violence Affective impulsivity due to anger Predatory Premeditated Biologically induced Caused by brain dysfunction Use same principles for assessment as with suicide Homicide Assessment Risk factors Pastviolence Sex age environment Psychiatric disorders Antisocial personality Borderline personality Alcoholism and drug abuse Triad of Violence Alerts Recent serious act of violence Psychotic processes that may precipitate violence Command hallucinations Alien control Hyperreligiosity Stated intent to perpetrate Eliciting Information about Violence Don t rely solely on info from pt Gather supplemental info from family and friends Pay attention to Tarasoff mandate
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