Study Notes for the Clinical MSW Exam

(1) Identify needs (2) Refer Client (3) R/O physical causes (4) Explore issues (5) Discuss incident (6) Pay attention to what information is and is not included (7) Refer resident for a competency evaluation (8) Assess client risk factors of suicide (9) Encourage client to discuss feelings (10) Establish clear boundaries (12) Describe the program benefits and requirements (13) Validate client’s feelings (14) Explore client understanding of the illness and the significance of medical treatment (15) Re-evaluate their systems of resources (16) Discuss w/SW how these behaviors interfere w/job performance (Clinical Supervisor) (17) Schedule an individual appointment w/client to discussion decision to terminate (18) Client concern regarding the therapist values (19) Meet w/the child to develop problem-solving strategies (20) Refer client for a physical examinations (21) Help the family address the expressed needs (22) Be aware of the meaning of different communication styles (23) Obtain consent from subjects (24) Explore family feelings (25) Collect information from teachers/primary physician/coaches etc (26) Clarify parents understanding of the reason for referral (27) Explain that information cannot be disclosed without consent (28) Provide the parents w/education about normal adolescent behavior (29) Complete an eligibility assessment (30) Acknowledge the clients feelings of distress and frustration (31) Comment about the incongruence in the communication (31) Explain that social history is needed to provide appropriate services (32) Explore the impact of this experience on the client (33) Report neglect (34) Clarify SW role w/client anticipating a conflict of interest (35) Point of pattern of resistance (36) Client bias; seek clinical supervision (37) When gathering information acknowledge each persons specific concerns (38) Ask couple what would change if SUD stop (Impasse) (39) Receive training in personal safety (40) Explore dynamics of the marital relationship (41) Explore the mother’s feelings about immunizations (42) Explore parent/child roles late-life families (43) Refer emergency assistance (44) Discuss ethical guidelines (45) Use previous hospital records until the client can give information (disoriented) (46) Explore the reason for lack of sexual activity (47) Explain attitudes about sex is important (48) Involve resident in program design (49) Allow students to express their feelings (50) Explore client own feelings about homosexuality (51) Reassure students that their feelings are normal (52) Inform client that child protective services will be notified

Clarify meaning of physical threats before reporting Provide information about services and how to obtain them Help wife who’s experiencing domestic violence w/safety plan Encourage parents to address school concerns Asian Culture: encourages the resolution of the problem within the family Only a nurse or a physician can authorize removal of restraints Rationalization: “Wasn’t my fault” Sexual abuse- A decline in personal hygiene, school grades, and social activities COD’s client refer for a medication evaluation Child Welfare SW: Conducts an abuse investigation (Not clinical SW) Children who abuse other children sexually were also victims of abuse Consult supervisor of personal bias Provide a victim of domestic violence information regarding domestic violence Refugee Couples: Explore how their change of status is affecting relationship “You just don’t understand” Clarify (Cultural Competency) BPD learn patterns of dealing with stress 15 year old having sex: Discuss the potential risk of behavior SW must always assess suicide risk To gather information for ADHD/ODD/CD/Abuse from teachers/parents/primary care physician etc Speak privately with colleague about concerns (e.g. suspected alcohol abuse etc) Help client with denials through appeals Always assess individuals and families reasons for them seeking therapy Explore behavior to all stages of development Social should acknowledge difficulty of the issues being discussed is supportive and could help the process Transference: Client’s thoughts and feelings toward the SW based on past relationships Acknowledge difficulties being discussed Avoidance: Finding discussion of the identified problem by focusing on unrelated issues Always build on clients strengths Always explore client self-determination Always explore presenting problems in initial assessment Always address client concerns before in a therapeutic alliance Advocacy requires information about the population and clear understanding Always be aware of different communication styles and cross cultural communication Always allow client to disclose at his/her own pace. Actively listen and convey efforts to understand Always explore family feeling in therapy Collect information from other sources when allowed Must have consent before releasing information SW must start where the client is at SW complete an eligibility assessment for client in need of financial, food, and medical assistance SW must educate client on child development SW must educate client on adolescent development SW must R/O physical and SUD when diagnosing diagnosis SW should always provide benefits and potential risk SW provide clear therapeutic boundaries to BPD SW explore expectations of client therapy when a transference issues exists SW helps increase client resources and referral base, when working with other community services NO dual relationships EVER SW should AVOID! Talking to group members or families outside the group dynamics (SW professionals as well) SW should gather information and research before filing compliant of unfairness SW should get client consent when doing case work SW is obligated to file the code of ethics and mandate report SW should always clarify roles and provide understanding to resistant clients SW should refer client that make poor decision based on self-care for a competency test Zoloft: Sexual side effects Closing social services in communities affect the underserved population the most Program Evaluation: (1) Need for services (2) Client satisfaction (3) meet requirements of funders SW should always explain the agencies policies SW should comment on in-congruency from clients SW should always explain the benefits for gathering information When an individual client case-close and they seek marital client, SW should communicate the possible conflict of interest SW should contract seeking help when losing control Refocus staff back on client when in disagreement regarding appropriate services SW should always point out a client pattern of resistance Initial meeting SW should acknowledge disagreeing families concerns and perspectives SW should allow the client to decide if he/she identified a SW defensiveness as a problem SW should receive safety training in unsafe communities

Normal Symbiotic Phase: According to Mahler, this phase extends from the first signs of conscious awareness at four to six weeks until about five months of age. (Mahler originally called the first few weeks of helpless infancy the “Normal Autistic Phase”, but later discarded this designation). In the Normal-Symbiotic Phase the infant is now aware of its mother, but has no sense of individuality of its own. The infant and mother are as one, and there is a barrier between them and the rest of the world.

Separation-Individuation Phase In this phase the infant breaks out of its “autistic shell” and begins to connect with its environment and with the people in it. Separation refers to the development of limits and to the differentiation in the infant’s mind between the infant and the mother, whereas individuation refers to the development of the infant’s ego, sense of identity, and cognitive abilities. This phase is divided into three sub-phases, which occur in the following order, but which often overlap in time:

1) Hatching. [5 to 9 months]. The infant becomes aware of the differentiation between itself and its mother. It becomes increasingly aware of its surroundings and interested in them, using its mother as a point of reference or orientation.

2) Practicing. [9 to 16 months]. The infant can now get about on its own, first crawling and then walking freely. The infant begins to explore actively and becomes more independent of its mother. The infant still experiences itself as one with its mother.

3) Rapprochement. [15 months and beyond] The young child once again becomes close to his mother, but begins to differentiate itself from his mother. The child realizes that his physical mobility demonstrates psychic separateness from his mother. The toddler may become tentative at this point, wanting his mother to be in sight so that, through eye contact and action, he can explore his world.

Mahler further divided Rapprochement into three sub-stages:

A) Beginning. The young child is motivated by a desire to share discoveries with his mother.

B) Crisis. The child is torn between staying connected with his mother and venturing out from his mother and becoming more independent and adventurous.

C) Solution. The child resolves the above Crisis according to the dictates of his own newly forming individuality, to his fledgling use of language, and to his interaction with the temperament of his mother.

Mahler believed that disruptions in the fundamental process of separation-individuation could result later in life in a disturbance in the ability to maintain a reliable sense of individual identity. Object Constancy: Maintaining a lasting relationship with a specific object, or rejecting any substitute for such an object. Example of the latter: rejecting mothering from anyone except one’s own mother. Mahler: object constancy is “the capacity to recognize and tolerate loving and hostile feelings toward the same object; the capacity to keep feelings centered on a specific object; and the capacity to value an object for attributes other than its function of satisfying needs.” Splitting this occurs when a person (especially a child) can’t keep two contradictory thoughts or feelings in mind at the same time, and therefore keeps the conflicting feelings apart and focuses on just one of them.

Avoidance: A defense mechanism consisting of refusal to encounter situations, objects, or activities because they represent unconscious sexual or aggressive impulses and/or punishment for those impulses; avoidance, according to the dynamic theory, is a major defense mechanism in phobias. Denial: Failing to recognize obvious implications or consequences of a thought, act, or situation. Examples: (1) a person having an extramarital affair gives no thought to the possibility of pregnancy. (2) Persons living near a volcano disregard the dangers involved. (3) A disabled person plans to return to former activities without planning a realistic program of rehabilitation Displacement: A change in the object by which an instinctual drive is to be satisfied; shifting the emotional component from one object or idea to another. Examples: (1) a woman is abandoned by her fiancé’; she quickly finds another man about whom she develops the same feelings; (2) a salesman is angered by his superior but suppresses his anger; later, on return to his home, he punishes one of his children for misbehavior that would usually be tolerated or ignored. Introjections: The process of assimilation of the picture of an object (as the individual conceives the object to be). For example, when a person becomes depressed due to the loss of a loved one, his feelings are directed to the mental image he possesses of the loved one. Projection: Attributing one’s thoughts or impulses to another person. In common use, this is limited to unacceptable or undesirable impulses. Examples: (1) a man, unable to accept that he has competitive or hostile feelings about an acquaintance, says, “He doesn’t like me.” (2) A woman, denying to herself that she has sexual feelings about a co-worker, accuses him, without basis, of flirt and described him as a “wolf.” Projection Identification: As in projection, the individual deals with emotional conflict or internal or external stressors by falsely attributing to another his or her own unacceptable feelings, impulses, or thoughts. Unlike simple projection, the individual does not fully disavow what is projected. Instead, the individual remains aware of his or her own affects or impulses but miss-attributes them as justifiable reactions to the other person. Not infrequently, the individual induces the very feelings in others that were first mistakenly believed to be there, making it difficult to clarify who did what to whom first. Rationalization: Offering a socially acceptable and apparently more or less logical explanation for an act or decision actually produced by unconscious impulses. The person rationalizing is not intentionally inventing a story to fool someone else, but instead is misleading self as well as the listener. Examples: (1) a man buys a new car, having convinced himself that his older car won’t make it through the winter. (2) A woman with a closet full of dresses buys a new one because she doesn’t have anything to wear. Reaction Formation: Going to the opposite extreme; overcompensation for unacceptable impulses. Examples: (1) a man violently dislikes an employee; without being aware of doing so, he “bends over backwards” to not criticize the employee and gives him special privileges and advances. (2) A person with strong antisocial impulses leads a crusade against vice. (3) A married woman who is disturbed by feeling attracted to one of her husband’s friends treats him rudely. Regression: By another anxiety-evading mechanism known as regression, the personality may suffer a loss of some of the development already attained and may revert to a lower level of adaptation and expression. Somatization: Conflicts are represented by physical symptoms involving parts of the body innervated by the sympathetic and parasympathetic system. Example: a highly competitive and aggressive person, whose life situation requires that such behavior be restricted, develops hypertension Sublimation: Attenuating the force of an instinctual drive by using the energy in other, usually constructive activities. This definition implies acceptance of the Libido Theory; the examples do not require it. Sublimation is often combined with other mechanisms, among them aim inhibition, displacement, and symbolization. Examples: (1) a man who is dissatisfied with his sex life but who has not stepped out on his wife becomes very busy repairing his house while his wife is out of town. Thus, he has no time for social activities. (2) A woman is forced to undertake a restrictive diet; she becomes interested in painting and does a number of still life pictures, most of which include fruit. Substitution: Through this defense mechanism, the individual secures alternative or substitutive gratification comparable to those that would have been employed had frustration not occurred. Undoing: An act or communication which partially negates a previous one. Examples: (1) two close friends have a violent argument; when they next meet, each act as if the disagreement had never occurred. (2) When asked to recommend a friend for a job, a man makes derogatory comments which prevent the friend’s getting the position; a few days later, the man drops in to see his friend and brings him a small gift.

THE IDENTIFIED PATIENT The identified patient (IP) is the family member with the symptom that has brought the family into treatment. Children and adolescents are frequently the IP in family therapy. The concept of the IP is used by family therapists to keep the family from scapegoat the IP or using him or her as a way of avoiding problems in the rest of the system. HOMEOSTASIS (BALANCE) Homeostasis means that the family system seeks to maintain its customary organization and functioning over time and it tends to resist change. The family therapist can use the concept of homeostasis to explain why a certain family symptom has surfaced at a given time, why a specific member has become the IP, and what is likely to happen when the family begins to change. THE EXTENDED FAMILY FIELD The extended family field includes the immediate family and the network of grandparents and other relatives of the family. This concept is used to explain the intergenerational transmission of attitudes, problems, behaviors, and other issues. Children and adolescents often benefit from family therapy that includes the extended family. DIFFERENTIATION Differentiation refers to the ability of each family member to maintain his or her own sense of self, while remaining emotionally connected to the family. One mark of a healthy family is its capacity to allow members to differentiate, while family members still feel that they are members in good standing of the family. TRIANGULAR RELATIONSHIPS Family systems theory maintains that emotional relationships in families are usually triangular. Whenever two members in the family system have problems with each other, they will "triangle in" a third member as a way of stabilizing their own relationship. The triangles in a family system usually interlock in a way that maintains family homeostasis. Common family triangles include a child and his or her parents; two children and one parent; a parent, a child, and a grandparent; three siblings; or, husband, wife, and an in-law. In the early 2000s, a new systems theory, multisystem therapy (MST), has been applied to family therapy and is practiced most often in a home-based setting for families of children and adolescents with serious emotional disturbances. MST is frequently referred to as a "family-ecological systems approach" because it views the family's ecology, consisting of the various systems with which the family and child interact (for example, home, school, and community). Several clinical studies have shown that MST has improved family relations, decreased adolescent psychiatric symptoms and substance use, increased school attendance, and decreased re-arrest rates for adolescents in trouble with the law. In addition, MST can reduce out-of-home placement of disturbed adolescents. Mood-Congruent if they are consistent with a patient's current mood or in keeping with current circumstances. For example: Feeling sad when someone close dies, having a hallucination of seeing and/or talking with a family member who recently died, smiling when one receives a gift

The oral stage occurs earliest. Newborn babies are initially limited to sucking and drinking. Their sexual instinctual drive is therefore focused around the mouth, initially in passive sucking and chewing. Later, pleasure is derived from more aggressive biting and chewing. Fixations, which persist beyond each developmental stage, are manifested through the oral stage as thumb sucking or cigarette smoking. The anal stage, which occurs in toddlers, is subdivided into two phases – the expressive period, in which the child derives pleasure in expelling faces, and the retentive period, in which they derive pleasure from storing it. The anal stage coincides with toilet training in the child, and is marked by ‘conflicts with parents about compliance and defiance’ (Ibid 536). The phallic stage is one of the most significant in the Freudian model. Children obtain pleasure from stimulating their genitals and begin to discriminate between the sex roles of their parents. Initially, a child in the phallic stage will identify with the parent of the opposite sex in what is known as the Oedipus complex. Briefly, the Oedipus complex posits that the ‘… child’s urges seek an external object. The inevitable object is his mother’. This naturally leads to hostility towards the father-figure. The Oedipal phase of the phallic stage gives way to one in which identification with the same-sex parent occurs. Such identification helps to form perception of gender roles and personality. A latency stage occurs before the onset of puberty and is marked by the dormancy of the libido. Sexual and aggressive drives are channeled into more socially acceptable substitutes. Finally, the genital stage, coinciding with puberty, marks the return of conscious sexuality and finds its cathexis in the genitals. Emotional maturity is ultimately attained in this stage, although elements, in the form of fixations, from the earlier stages often remain. The term psychoanalysis is used to refer to many aspects of Freud’s work and research, including Freudian therapy and the research methodology he used to develop his theories. Freud relied heavily upon his observations and case studies of his patients when he formed his theory of personality development. Before we can understand Freud’s theory of personality, we must first understand his view of how the mind is organized. According to Freud, the mind can be divided into two main parts: The conscious mind includes everything that we are aware of. This is the aspect of our mental processing that we can think and talk about rationally. A part of this includes our memory, which is not always part of consciousness but can be retrieved easily at any time and brought into our awareness. Freud called this ordinary memory the preconscious. The unconscious mind is a reservoir of feelings, thoughts, urges, and memories that outside of our conscious awareness. Most of the contents of the unconscious are unacceptable or unpleasant, such as feelings of pain, anxiety, or conflict. According to Freud, the unconscious continues to influence our behavior and experience, even though we are unaware of these underlying influences.

Pre-conventional The pre-conventional level of moral reasoning is especially common in children, although adults can also exhibit this level of reasoning. Reasoners at this level judge the morality of an action by its direct consequences. The pre-conventional level consists of the first and second stages of moral development, and is solely concerned with the self in an egocentric manner. A child with preconventional morality has not yet adopted or internalized society's conventions regarding what is right or wrong, but instead focuses largely on external consequences that certain actions may bring. In Stage one (obedience and punishment driven), individuals focus on the direct consequences of their actions on themselves. For example, an action is perceived as morally wrong because the perpetrator is punished. "The last time I did that I got spanked so I will not do it again." The worse the punishment for the act is, the more "bad" the act is perceived to be.^[15] This can give rise to an inference that even innocent victims are guilty in proportion to their suffering. It is "egocentric", lacking recognition that others' points of view are different from one's own.^[16] There is "deference to superior power or prestige".^[16] Stage two (self-interest driven) espouses the "what's in it for me" position, in which right behavior is defined by whatever is in the individual's best interest. Stage two reasoning shows a limited interest in the needs of others, but only to a point where it might further the individual's own interests. As a result, concern for others is not based on loyalty or intrinsic respect, but rather a "you scratch my back and I'll scratch yours" mentality.^[2] The lack of a societal perspective in the pre-conventional level is quite different from the social contract (stage five), as all actions have the purpose of serving the individual's own needs or interests. For the stage two theorists, the world's perspective is often seen as morally relative. Conventional The conventional level of moral reasoning is typical of adolescents and adults. Those who reason in a conventional way judge the morality of actions by comparing them to society's views and expectations The conventional level consists of the third and fourth stages of moral development. Conventional morality is characterized by an acceptance of society's conventions concerning right and wrong. At this level an individual obeys rules and follows society's norms even when there are no consequences for obedience or disobedience. Adherence to rules and conventions is somewhat rigid, however, and a rule's appropriateness or fairness is seldom questioned. In Stage three (interpersonal accord and conformity driven), the self enters society by filling social roles. Individuals are receptive to approval or disapproval from others as it reflects society's accordance with the perceived role. They try to be a "good boy" or "good girl" to live up to these expectations, having learned that there is inherent value in doing so. Stage three reasoning may judge the morality of an action by evaluating its consequences in terms of a person's relationships, which now begin to include things like respect, gratitude and the "golden rule". "I want to be liked and thought well of; apparently, not being naughty makes people like me." Desire to maintain rules and authority exists only to further support these social roles. The intentions of actions play a more significant role in reasoning at this stage; "they mean well ...". In Stage four (authority and social order obedience driven), it is important to obey laws, dictums and social conventions because of their importance in maintaining a functioning society. Moral reasoning in stage four is thus beyond the need for individual approval exhibited in stage three; society must learn to transcend individual needs. A central ideal or ideals often prescribe what is right and wrong, such as in the case of fundamentalism. If one person violates a law, perhaps everyone would—thus there is an obligation and a duty to uphold laws and rules. When someone does violate a law, it is morally wrong; culpability is thus a significant factor in this stage as it separates the bad domains from the good ones. Most active members of society remain at stage four, where morality is still predominantly dictated by an outside force.^[2] Post-Conventional The post-conventional level, also known as the principled level, consists of stages five and six of moral development. There is a growing realization that individuals are separate entities from society, and that the individual’s own perspective may take precedence over society’s view; they may disobey rules inconsistent with their own principles. These people live by their own abstract principles about right and wrong—principles that typically include such basic human rights as life, liberty, and justice. Because of this level’s “nature of self before others”, the behavior of post-conventional individuals, especially those at stage six, can be confused with that of those at the pre-conventional level. People who exhibit postconventional morality view rules as useful but changeable mechanisms—ideally rules can maintain the general social order and protect human rights. Rules are not absolute dictates that must be obeyed without question. Contemporary theorists often speculate that many people may never reach this level of abstract moral reasoning. In Stage five (social contract driven), the world is viewed as holding different opinions, rights and values. Such perspectives should be mutually respected as unique to each person or community. Laws are regarded as social contracts rather than rigid edicts. Those that do not promote the general welfare should be changed when necessary to meet “the greatest good for the greatest number of people”.^[8] This is achieved through majority decision, and inevitable compromise. Democratic government is ostensibly based on stage five reasoning. In Stage six (universal ethical principles driven), moral reasoning is based on abstract reasoning using universal ethical principles. Laws are valid only insofar as they are grounded in justice, and a commitment to justice carries with it an obligation to disobey unjust laws. Rights are unnecessary, as social contracts are not essential for demonic moral action. Decisions are not reached hypothetically in a conditional way but rather categorically in an absolute way, as in the philosophy of Immanuel Kant.^[17] This involves an individual imagining what they would do in another’s shoes, if they believed what that other person imagines to be true.^[18] The resulting consensus is the action taken. In this way action is never a means but always an end in itself; the individual acts because it is right, and not because it is instrumental, expected, legal, or previously agreed upon. Although Kohlberg insisted that stage six exists, he found it difficult to identify individuals who consistently operated at that level.^[14]

Piaget believed that young people pass through four stages as they develop; sensorimotor, preoperational, concrete-operational and formal-operational. Sensorimotor: infants explore the world through their senses and motor activity. They work towards mastering object permanence (now-you-see-it, now-you-don't) and performing goal-directed activities. Preoperational: children explore symbolic thinking and logical operations. Concrete-operational: children in this stage can think logically about tangible situations and can demonstrate conservation, reversibility, classification and seriation. Formal-operational: this stage marks the onset of the ability to perform hypothetical and deductive reasoning as well as imagine other worlds.

Heinz Hartmann introduced the concepts of primary and secondary ego autonomy in 1939, and elaborated on them in later writings (Hartmann, 1964). Within the framework of his description lies a conflict-free sphere of the ego. The notion of "ego autonomy" implies that the ego and the id derive from a common matrix where certain ego precursors prefigure functions destined to develop autonomously, independently of the instincts and their vicissitudes. Primary and secondary autonomy involve two sets of hypotheses, which together constitute the conflict-free ego sphere. Hartmann replaced Freud's view that the ego grows out of the id with the hypothesis that both ego and id are derived from a common undifferentiated medium. Related concepts are change of function, neutralization, automatization, and ego interests. Hartmann focused especially on the autonomy of specific ego functions, and stressed that ego autonomy is relative, since both primary and secondarily autonomous components can be drawn into conflict.

Infancy (birth to 18 months) Trust vs. Mistrust Feeding Children develop a sense of trust when caregivers provide reliability, care, and affection. A lack of this will lead to mistrust. Early Childhood (2 to 3 years) Autonomy vs. Shame and Doubt Toilet Training Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt. Preschool (3 to 5 years) Initiative vs. Guilt Exploration Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. School Age (6 to 11 years) Industry vs. Inferiority School Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority. Adolescence (12 to 18 years) Identity vs. Role Confusion Social Relationships Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self. Young Adulthood (19 to 40 years) Intimacy vs. Isolation Relationships Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation. Middle Adulthood (40 to 65 years) Generativity vs. Stagnation Work and Parenthood Adults need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world. Maturity(65 to death) Ego Integrity vs. Despair Reflection on Life Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair.

Cluster A (odd or eccentric disorders) Paranoid personality disorder (DSM-IV code 301.0): characterized by irrational suspicions and mistrust of others. Schizoid personality disorder (DSM-IV code 301.20): lack of interest in social relationships, seeing no point in sharing time with others, anhedonia, introspection. Schizotypal personality disorder (DSM-IV code 301.22): characterized by odd behavior or thinking. Cluster B (dramatic, emotional or erratic disorders) Antisocial personality disorder (DSM-IV code 301.7): a pervasive disregard for the law and the rights of others. Borderline personality disorder (DSM-IV code 301.83): extreme "black and white" thinking, instability in relationships, self-image, identity and behavior often leading to self-harm and impulsivity. Borderline personality disorder is diagnosed in 3 times as many females as males.^[5] Histrionic personality disorder (DSM-IV code 301.50): pervasive attention-seeking behavior including inappropriately seductive behavior and shallow or exaggerated emotions. Narcissistic personality disorder (DSM-IV code 301.81): a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Cluster C (anxious or fearful disorders) Avoidant personality disorder (DSM-IV code 301.82): social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction. Dependent personality disorder (DSM-IV code 301.6): pervasive psychological dependence on other people. Obsessive-compulsive personality disorder (not the same as obsessive-compulsive disorder) (DSM-IV code 301.4): characterized by rigid conformity to rules, moral codes and excessive orderliness.

Task-Centered Therapy
It was developed based on a short-term psychodynamic model. Basically, the course of treatment is short (approximately 8 sessions), its focus is on key problems, and the therapist helps the client to develop specific goals. Task-Centered model is heavily influenced by the behavioral model, the problem-solving approach, and learning theory. Task-centered therapy attempts to promote change in behavior using specific tasks (usually performed outside the session by the client). Task-centered approach seems to share certain key assumptions - for example, most people have adequate resources to solve their problems, most people have the innate desire to solve their problems, and that most problems occur in the context of individual, family, and environmental systems that may at times block or facilitate their solution.
There are three phases in this task-centered approach – a) Initial: Identifying problems, b) Middle phase: Plan and take actions toward solution (including reviewing progress, client engaging and participating, c) Termination: Begins in the first session (the therapist outlines suggested times limits for the intervention, reviews accomplishment, and what remains to be done).

Problem-solving Approach
With its roots in the diagnostic school, the problem approach offers a logical process for assessing a social problem, reviewing options for addressing it, and working out a plan designed for its amelioration.
The core idea of this approach is that success could be achieved by partializing – or separating into manageable segments - a client’s intertwined problems and focusing on one specific issue the client and the social worker agreed needed to be resolved at a given time.

I was not able to find any info about the steps for the problem-solving approach. But generally, it does look somewhat similar to the task-centered approach because both focus on certain tasks to accomplish goals. How do you find either or both approaches helpful to your job? If possible, please share an example.

Strategic Therapy (Haley) How one used communication to increase ones role in a relationship to advance their position (i.e. power struggle) Power struggles are normal behavior in a rel. They become pathological when one denies their intent to control and this causes symptomatic behavior. Focus on alleviating current symptoms by altering transactions especially in the hierarchies, generational boundaries etc. Social Stage-observe family members & involve all 2. Prob. Stage-therapist gathers info about the reasons family came to therapy. 3. Interaction Stage-Family members. Discuss ID prob. & therapist observes to gather more info. 4. Goal Setting-Therapist and Family members agree on a contract which defines the goals for treatment. Systemic Therapy (Milan) Emphasizes understanding- help family see their choices and exercise their prerogative in using them. Circular patters of actions and reactions where the family gets so fixed ~ they are unable to be flexible or change. 3 Therapist - team approach. Family is observed behind a 3 way mirror. 2 therapists meet w/ family and 1 observes from behind the mirror 1. Hypothesizing 2. Circularity of actions/reactions 3 Therapist remains neutral & does not get involved in alliances etc. 1. Perspective (who was more upset? mom or dad?) 2. Now/Then. (When did the behavior. begin? before or after the accident) 3. Differences in degree (How would you rate your anxiety on a scale of 1-5) 4. Hypothetical (what if mom and dad divorced?) Milan Systemic Family Therapy Makes use of paradoxical strategies: 1. counter-paradox (therapeutic double-bind) 2. Positive Connotation (reframe) 3 Paradoxical Prescription Interpersonal Family Therapy (Swatz) 1. An individual psyche is made of separate parts with an essential self at the core. 2. Each part wants something pos. for the individual. & will assert itself. 3. Each part has a role that evolved out of interplay between social and developmental environment. Exile 2. Managers 3. Firefighters Parts that have become isolated b/c trauma & attempt to protect the rest of the system from pain/fear *Can b/c extreme in an effort to be cared for & heard Parts that run daily life Protect from hurt & pain. Attempt to keep ctrl. & keep exiles suppressed. Groups of parts that are activated when exiles surface ~ try to extinguish painful feelings and memories Use bad strategies like: addiction, self-mutilation, sexual acting out etc. Everyone has a healthy & healing Self @ the core. The self role is to modulate the input of these parts & lead the internal organizational system. People who are out of touch w/ their core self tend to be overwhelmed by emotion. or ruled by maladaptive sub personalities. The goal of IFS is to help the core b/c the anchoring ctr. of the sub-personalities. I.e. a Super-Ego that harmonizes the needs of the parts * Help the Parts find non-extreme expressions -led by the core self.

AB Design: A single-system research design for comparing client functioning during treatment (intervention) with client functioning before treatment (baseline). The AB is used to monitor client change and evaluate treatment outcomes Abstract: Expressing a quality or characteristic apart from any specific object or instance, as justice, poverty, and speed. Theoretical; not applied or practical: abstract science. Acculturation Difficulty: A problem stemming from an inability to appropriately adapt to a different culture or environment. The problem is not based on any coexisting mental disorder Actualization: The realization of one’s full potential (intellectual, psychological, physical) Advocacy: To speak in favor of an issue, to plead the case for another, or to champion a cause often for individuals and groups that cannot speak out on their behalf Agoraphobia: Anxiety about being in places or situations in which escape might be difficult or embarrassing or in which help may not be available should a panic attack occur. The fears typically relate to venturing into the open, of leaving the familiar setting of one's home, or of being in a crowd, standing in line, or traveling in a car or train. Although agoraphobia usually occurs as a part of panic disorder, agoraphobia without a history of panic disorder has been described as also occurring without other disorders Agonist Medication: A chemical entity that is not naturally occurring within the body which acts upon a receptor and is capable of producing the maximal effect that can be produced by stimulating that receptor. A partial agonist is capable only of producing less than the maximal effect even when given in a concentration sufficient to bind with all available receptors Agonist/Antagonist Medication: A chemical entity that is not naturally occurring within the body which acts on a family of receptors (such as mu, delta, and kappa opiate receptors) in such a fashion that it is an agonist or partial agonist on one type of receptor while at the same time it is also an antagonist on another different receptor Alienation: The estrangement felt in a setting one views as foreign, unpredictable, or unacceptable. For example, in depersonalization phenomena, feelings of unreality or strangeness produce a sense of alienation from one's self or environment Anal Stage: The period of pregenital psychosexual development, usually from 1 to 3 years, in which the child has particular interest and concern with the process of defecation and the sensations connected with the anus. The pleasurable part of the experience is termed anal eroticism. Affect: Observable behavior that represent the expression of a subjectively experienced feelings state (sad, fear, joy, anger) Alliance/Coalition: In a family or group, relationships formed between two or more individuals that serve a specific function in influencing interpersonal dynamics Ambiguity in therapy: Forms of speech, metaphors, imagery, body movements, and so on, that stimulates a search process in the listeners to find their own relevant meaning Ambiguous: open to or having several possible meanings or interpretations; equivocal: an ambiguous answer. Antecedent: An environmental event or stimulus that precedes a response. Anxiolytics: A class of drugs that reduce anxiety Archetypes: instinct/ideas, patterns of thought, image; inherited from the ancestors of this race and universally presents in individual psyche. Subconscious image which we are born with and carry throughout our lives Assertive Community Treatment (ACT): An environment-based service delivery model in which the same clinical team, using largely outreach methods, provides comprehensive community-based treatment, rehabilitation, and supportive services to persons with severe and persistent illnesses Assessment: Systematically collecting data about client’s functioning and monitoring progress in a client functioning on an ongoing basis. SW identifies and measure specific problem behaviors. Information is gathered from variety of sources. Type’s multi-dimensional/crisis assessment/functional analysis/behavioral measurements/mental status exams/biopsychosocial Assimilation: A Piagetian term describing a person's ability to comprehend and integrate new experiences. Avolition: An inability to initiate and persist in goal-directed activities. When severe enough to be considered pathological, avolition is pervasive and prevents the person from completing many different types of activities (e.g., work, intellectual pursuits, and self-care). Baseline: Assessment phase of practice, when the frequency of a specific behavior, client functioning, or attitudes are measured over time prior to an intervention Behavioral Family Therapy: Modify behavior and cognitive perceptions in families Belligerent: Warlike character; aggressively hostile; bellicose: a belligerent tone. Best practice: A technique or methodology that, through empirical research, has proven in the past to be reliable Biopsychosocial Model: Social and environmental triggers must be present to bring about potential illness Bipolar I: A level of depression characterized by presence of episodes of major depressive disorder and at least one documented manic or mixed episode Bipolar II: A level of depression characterized by at least one major depressive episode that is accompanied by at least one hypomanic episode Blight: The state or result of being blighted or deteriorated; dilapidation; decay: urban blight. Borderline Personality Disorder: A pervasive pattern of instability of interpersonal relationships, self-image, and affect, along with marked impulsivity that begins by early adulthood and is present in a variety of contexts. People with BPD have among the highest suicide, attempted suicide, and mental health utilization rates of those with any psychiatric disorder Boundaries: Spoken and unspoken rules that case managers and clients observe about the physical and emotional limits of their relationship Broker: Case manager who conducts assessment, develop care plans, and makes referral to provider agencies for services Case Management: Services that link and coordinates assistance from institutions and agencies providing medical, psychosocial, and concrete support for individuals in need of such assistance Catharsis: The emotional relief experienced following the process of revealing one’s inner anxieties and conflicts Classical Conditioning (Pavlov): The concept is that a certain action or external environment factors can produce a response that is normally associated with a different action or environmental factor. Code of Ethics: A formal document ratified by a group or organization containing ethical principles, guidelines, and standards Concept: Notion or idea. Condensation: A psychological process, often present in dreams, in which two or more Concepts are fused so that a single symbol represents the multiple components Conversion: A defense mechanism, operating unconsciously, by which intrapsychic conflicts that would otherwise give rise to anxiety are instead given symbolic external expression. The repressed ideas or impulses, and the psychological defenses against them, are converted into a variety of somatic symptoms. These may include such symptoms as paralysis, pain, or loss of sensory function Cognitive-Behavioral Therapy: Treatment model emphasizing the primacy of thoughts and beliefs in influencing feelings and subsequent actions. Interventions include social skills training, problem-solving, cognitive restructuring, and communication skills training Comorbidity: When two or more diseases or condition that co-exists or co-occur Concrete Thinking: immediate experience, rather than abstract Conform: to act in accord with the prevailing standards, attitudes, practices, etc., of society or a group: Core Beliefs: Basic beliefs about oneself, others, and the world are formed early in childhood and are relatively inaccessible to awareness Counter-Transference: occurs when the therapist begins to project his or her own unresolved conflicts onto the client. While transference of the client’s conflicts onto the therapist is considered a healthy and normal part of psychodynamic therapy, the therapist’s job is to remain neutral. At one time, counter-transference was widely believed to contaminate the therapeutic relationship. Current thinking is more complex. Cultural Competent Practice: The ability to recognize similarities and differences in culture; when a SW comprehends the norms of conduct, beliefs, traditions, values, language art skills, and interpersonal relationship within a society Depersonalization: An alteration in the perception or experience of the self so that one feels detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream) Dichotomy: Division into two mutually exclusive, opposed, or contradictory groups: a dichotomy between thought and action. Dissociation: A disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. The disturbance may be sudden or gradual, transient or chronic Double Bind: Interaction in which one person demands a response to a message containing mutually contradictory signals, while the other person is unable either to comment on the incongruity or to escape from the situation Dysphoric: Unpleasant mood such as sadness, anxiety, or irritability Dyad: A two-person relationship, such as the therapeutic relationship between doctor and patient in individual psychotherapy DSM-IV: Diagnostic assessment requires, significant impairment that may supported observation of friends, co-workers, and families etc Echolalia: The pathological, parrot-like, and apparently senseless repetition (echoing) of a word or phrase just spoken by another person. Echolalia Parrot-like repetition of overheard words or fragments of speech Echopraxia: Repetition by imitation of the movements of another. The action is not a willed or voluntary one and has a semiautomatic and uncontrollable quality Ego-Dystonic: Referring to aspects of a person's behavior, thoughts, and attitudes that are viewed by the self as repugnant or inconsistent with the total personality Etiology: the study of the causes of diseases Expansive Mood: Lack of restraint in expressing one's feelings, frequently with an overvaluation of one's significance or importance; irritable easily annoyed and provoked to anger

Disposition: The predominant or prevailing tendency of one's spirits; natural mental and emotional outlook or mood; characteristic attitude: a girl with a pleasant disposition. State of mind regarding something; inclination: a disposition to gamble. Focal: of or pertaining to a focus Flooding: A behavior therapy procedure for phobias and other problems involving maladaptive anxiety, in which anxiety producers are presented in intense forms, either in imagination or in real life Free Association: In psychoanalytic therapy, spontaneous, uncensored verbalization by the patient of whatever comes to mind Germane: closely or significantly related; relevant; pertinent Heterogeniety/Heterogenuous: composed of parts of different kinds; having widely dissimilar elements or constituents: Id: In Freudian theory, the part of the personality that is the unconscious source of unstructured desires and drives Ideas of Reference: Incorrect interpretations of casual incidents and external events as having direct reference to oneself. May reach sufficient intensity to constitute delusions Indulge: to yield to an inclination or desire; allow oneself to follow one's will Illusion: A misperception or misinterpretation of a real external stimulus, such as hearing the rustling of leaves as the sound of voices. See also hallucination Libido: The psychic drive or energy usually associated with the sexual instinct. (Sexual is used here in the broad sense to include pleasure and love-object seeking) Impasse: A position or situation from which there is no escape; deadlock Loosening of associations: A disturbance of thinking shown by speech in which ideas shift from one subject to another that is unrelated or minimally related to the first statements that lack a meaningful relationship may be juxtaposed, or speech may shift suddenly from one frame of reference to another; The speaker gives no indication of being aware of the disconnectedness, contradictions, or illogicality of speech Magical Thinking: The erroneous belief that one's thoughts, words, or actions will cause or prevent a specific outcome in some way that defies commonly understood laws of cause and effect. Magical thinking may be a part of normal child development Negative Symptoms: Most commonly refers to a group of symptoms characteristic of schizophrenia that include loss of fluency and spontaneity of verbal expression, impaired ability to focus or sustain attention on a particular task, difficulty in initiating or following through on tasks, impaired ability to experience pleasure to form emotional attachment to others, and blunted affect Neurosis: A functional disorder in which feelings of anxiety, obsession thoughts, compulsive acts, and physical complaints without objective evidence of disease, in various degrees and patterns, dominate the personality. Obsession: Recurrent and persistent thought, impulse, or image experienced as intrusive and distressing. Recognized as being excessive and unreasonable even though it is the product of one’s mind This thought, impulse, or image cannot be expunged by logic or reasoning Object Relations: The emotional bonds between one person and another, as contrasted with interest in and love for the self; usually described in terms of capacity for loving and reacting appropriately to others Oedipal Stage: Overlapping some with the phallic stage, this phase (ages 4 to 6) represents a time of inevitable conflict between the child and parents. The child must desexualize the relationship to both parents in order to retain affectionate kinship with both of them. The process is accomplished by the internalization of the images of both parents, thereby giving more definite shape to the child’s personality. With this internalization largely completed, the regulation of self-esteem and moral behavior comes from within Operant Conditioning (Skinner): Conditioning is used to get a desired action by giving a reward, not normally associated with that action every time it is performed voluntarily. Oral Stage: The earliest of the stages of infantile psychosexual development, lasting from birth to 12 months or longer. Usually subdivided into two stages: the oral erotic, relating to the pleasurable experience of sucking; and the oral sadistic, associated with aggressive biting Both oral eroticism and sadism continue into adult life in disguised and sublimated forms, such as the character traits of demanding or pessimism. Oral conflict, as a general and pervasive influence, might underlie the psychological determinants of addictive disorders, depression, and some functional psychotic disorders Origin: the first stage of existence; beginning Pathological: Uncontrollable and Unreasonable. Phallic Stage: The period, from about 21/2 to 6 years, during which sexual interest, curiosity, and pleasurable experience in boys center on the penis, and in girls, to a lesser extent, the clitoris Pre-Disposition: Alcohol abuse in children with families who abuse alcohol Projection: A defense mechanism, operating unconsciously, in which what is emotionally unacceptable in the self is unconsciously rejected and attributed (projected) to others Projective Identification: A term introduced by Melanie Klein to refer to the unconscious process of projection of one or more parts of the self or of the internal object into another person (such as the mother). What is projected may be an intolerable, painful, or dangerous part of the self or object (the bad object). It may also be a valued aspect of the self or object (the good object) that is projected into the other person for safekeeping. The other person is changed by the projection and is dealt with as though he or she is in fact characterized by the aspects of the self that have been projected Reaction Formation: A defense mechanism, operating unconsciously, in which a person adopts affects, ideas, and behaviors that are the opposites of impulses harbored either consciously or unconsciously. For example, excessive moral zeal may be a reaction to strong but repressed asocial impulses Redundant: characterized by verbosity or unnecessary repetition in expressing ideas Separation-Individuation: Psychological awareness of one’s separateness, described by Margaret Mahler as a phase in the mother-child relationship that follows the symbiotic stage. In the separation-individuation stage, the child begins to perceive himself or herself as distinct from the mother and develops a sense of individual identity and an image of the self as object. Mahler described four subphases of the process: differentiation, practicing, rapprochement (i.e., active approach toward the mother, replacing the relative obliviousness to her that prevailed during the practicing period), and separation-individuation proper (i.e., awareness of discrete identity, separateness, and individuality) Shaping: Is the approach of using approximation Sublimation: A defense mechanism, operating unconsciously, by which instinctual drives, consciously unacceptable, are diverted into personally and socially acceptable channels Substantiate: To establish by proof or competent evidence: to substantiate a charge. Superego: In psychoanalytic theory, that part of the personality structure associated with ethics, standards, and self-criticism. It is formed by identification with important and esteemed persons in early life, particularly parents. The supposed or actual wishes of these significant persons are taken over as part of the child’s own standards to help form the conscience Suppression: The conscious effort to control and conceal unacceptable impulses, thoughts, feelings, or acts Splitting: A mental mechanism in which the self or others are reviewed as all good or all bad, with failure to integrate the positive and negative qualities of self and others into cohesive images Often the person alternately idealizes and devalues the same person Symbiosis: A mutually reinforcing relationship between two persons who are dependent on each other; a normal characteristic of the relationship between the mother and infant child Systematic Desensitization: A behavior therapy procedure widely used to modify behaviors associated with phobias. The procedure involves the construction of a hierarchy of anxiety-producing stimuli by the subject, and gradual presentation of the stimuli until they no longer produce anxiety Taboo: proscribed by society as improper or unacceptable Tangential: Replying to a question in an oblique or irrelevant way. Compare with circumstantiality Temperament: Constitutional predisposition to react in a particular way to stimuli Trichotillomania: The pulling out of one’s own hair to the point that it is noticeable and causing significant distress or impairment. Undoing: A mental mechanism consisting of behavior that symbolically atones for, makes amends for, or reverses previous thoughts, feelings, or actions Word Salad: A mixture of words and phrases that lack comprehensive meaning or logical coherence; commonly seen in schizophrenic states Paradoxical: a seemingly absurd or self-contradictory

Gestalt Therapy Psychotherapy that emphasizes personal responsibility, and that focuses upon the individual’s experience in the present moment, the therapist-client relationship, the environmental and social contexts of a person’s life and the self-regulating adjustments people make as a result of their overall situation. Here and Now Change comes about as a result of “full acceptance of what is, rather than a striving to be different Jung Therapy Theory of neurosis is based on the premise of a self-regulating psyche composed of tensions between opposing attitudes of the ego and the unconscious. A neurosis is a significant unresolved tension between these contending attitudes. Each neurosis is unique, and different things work in different cases, so no therapeutic method can be arbitrarily applied. Nevertheless, there is a set of cases that Jung especially addressed. Although adjusted well enough to everyday life, the individual has lost a fulfilling sense of meaning and purpose, and has no living religious belief to which to turn. There seems to be no readily apparent way to set matters right. In these cases, Jung turned to ongoing symbolic communication from the unconscious in the form of dreams and visions Resolution of the tension causing this type of neurosis involves a careful constructive study of the fantasies. The seriousness with which the individual (ego) must take the mythological aspects of the fantasies may compare with the regard that devoted believers have toward their religion. It is not merely an intellectual exercise, but requires the commitment of the whole person and realization that the unconscious has a connection to life-giving spiritual forces. Only a belief founded on direct experience with this process is sufficient to oppose, balance, and otherwise adjust the attitude of the ego When this process works, this type of neurosis may be considered a life-guiding gift from the unconscious, even though the personal journey forced upon the individual sometimes takes decades. This may seem absurd to someone looking at a neurosis from the attitude that it is always an illness that should not have to happen, expects the doctor to have a quick cure, and that fantasies are unreliable subjective experiences A significant aspect of Jung’s theory of neurosis is how symptoms can vary by psychological type. The hierarchy of discriminating psychological functions gives each individual a dominant sensation, intuition, feeling, or thinking function preference with either an extroverted or introverted attitude. The dominant is quite under the control of the ego. But the inferior function remains a gateway for unconscious contents. This creates typical manifestations of inferior insight and behavior when extreme function one-sidedness accompanies the neurosis Archetypes: instinct/ideas, patterns of thought, image; inherited from the ancestors of this race and universally presents in individual psyche. Subconscious image which we are born with and carry throughout our lives Bridge the gap between the conscious and unconscious Collective Unconscious: Vault of memories that is handed down from one generation to the next Personal Unconscious: Once conscious but are now unconscious Adler Theory According to Adler’s theory, each of us is born into the world with a sense of inferiority. We start as a weak and helpless child and strive to overcome these deficiencies by become superior to those around us. He called this struggle a striving for superiority; he saw this as the driving force behind all human thoughts, emotions, and behaviors. For those of us who strive to be accomplished writers, powerful business people, or influential politicians, it is because of our feelings of inferiority and a strong need to over come this negative part of us according to Adler. This excessive feeling of inferiority can also have the opposite effect; as it becomes overwhelming and without the needed successes, we can develop an inferiority complex. This belief leaves us with feeling incredibly less important and deserving than others, helpless, hopeless, and unmotivated to strive for the superiority that would make us complete. Healthy Style of life: Optimistic outlook and contribution to the welfare of others Mistaken Style of life: Self-centeredness and personal power