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3 Primary Duties re: Ethics: Duty to Protect Best Interest of Client
Duty to Honest Disclosure
Duty to Provide Treatment
Aptitude and Achievement Test: SAT
ACT
The Peabody Individual Achievement Test
The Wide Range Achievement Test (WRAT)
Boundary: Emotional barriers that protect and enhance the integrity of individuals, subsystems and families
Conscious: Mental activities of which we are fully aware
Disengagement: The psychological isolation that results from overly rigid boundaries around individuals and subsystems in a family
Double-bind: A conflict created when a person receives contradictory messages in an important relationship, and cannot leave or comment
Ego: Mediator between id and superego (between internal and external reality)
Enmeshment: Minuchin's term for loss of autonomy due to a blurring of psychological boundaries
Erikson's Stages: Trust v Mistrust (0-18mo)
Autonomy v Shame/Doubt (18-36mo)
Initiative v Guilt (3-6yr)
Industry v Inferiority (6-11yr)
Identity v Role Confusion (Adolescence)
Intimacy v Isolation (Early Adulthood)
Generativity v Stagnation (Middle Adulthood)
Integrity v Despair (Late Adulthood)
Ethics: Service
Social Justice
Integrity
Competence
Dignity and Worth of Person
Importance of Human Relationships
Family Drawing: An experiential therapy technique where family members are asked to draw their ideas about how the family is organized
Family myths: Beliefs of all family members based on a distortion of reality that help shape the family rules
Family rules: Expectations of how family members are expected to behave
Freuds Stages: Oral (0-18mo)
Anal (18-36mo)
Phallic (3-6yr)
Latency (6-11yr)
Genital (11-19yr)
Genogram: A schematic diagram of the family system
squares = men
circles = women
horizonatal lines = marriages
vertical lines = children
Identified Patient: The symptom bearer as identifed by the family
Intelligence Tests: Stanford-Binet
Weschler Adult Intelligence Scale (WAIS) (16+)
Weschler Intelligence Scale for Children (WISC) (5-15)
Weschler Preschool and Primary Scale of Intelligence (WIPPSI) (4-6 1/2)
Joining: Accepting and accommodating to families in order to win confidence and avoid resistence
Id: Primitive drives and instinctual needs
Mahler's Stages: Normal Autism (0-2mo)
Normal Symbiosis (2-6mo)
Hatching (6-9mo)
Practicing (9-18mo)
Rapproachment (15-36mo)
Object Constancy (36+mo)
Neuropsychological Tests: Bender Gestalt Visual Motor Test (5-adult)
Orgasmic Disorders: Female Orgasmic Disorder
Male Orgasmic Disorder
Premature Ejaculation
Paradox: A self-contradictory statement
Paradoxical directive: A technique used in strategic therapy whereby the therapist directs family members to continue their symptomatic behavior. If they conform, they admit control and expose secondary gain. If they rebel, they give up their symptoms
Parentified Child: A child who has been allocated power to take care of younger siblings; adaptive when done deliberately in large or single family homes, maladaptive when it results from unplanned withdrawal of parental responsibility
Objective Personality Tests: Minnesota MultiPhasic Personality Inventory (MMPI)
Projective Personality Tests: Adults: Rorschach and Thematic Apperception Test (TAT)
Children: Child Apperception Test (CAT), House-Tree-Person, and the Kinetic Family Drawings
Piaget's Stages: Sensorimotor (0-2yr)
Preoperational (2-7yr)
Concrete Operations (7-11yr)
Formal Operations (11+yrs)
Preconscious: Thoughts and feelings which can be brought into consciousness easily
Reframing: Relabeling a family's description of behavior to make it more amenable to therapeutic change
Sexual Arousal Disorders: Female Sexual Arousal Disorder
Male Erectile Disorder
Sexual Desire Disorders: Hypoactive Sexual Desire Disorder
Sexual Aversion Disorder
Sexual Pain Disorder: Dysparunia
Vaginismus
Superego: Conscience
Unconscious: Thoughts, feelings, desires, and memories of which we are unaware
Accommodation: Adapting to the events of the environment
Antipsychotic Meds: Thorazine
Haldol
Clozaril
Mellaril
Prolixin
Navane
Stelazine
Seroquel
Resperdal
Zyprexa
Assimilation: The integration of external elements into the evolving structure of the organism
Case manager: Person at the HMO, PPO, or insurance company that manages the benefits and the providers
Common Side Effects of Meds: Dry mouth
Blurred vision
Weight gain
Constipation
Sexual dysfunction (decreased libido)
Sedation
Dizziness
Movement disorders (pacing, grimacing, rigidity, tremors)
Denial: Primitive defense; inability to acknowledge true significance of thought, feelings, wishes, behavior, or external reality factors which are consciously intolerable
Dependent variable: Clinical condition (depression, anxiety, etc)
Devaluation: Defense mechanism frequently used by persons with narcissistic personality organization which is the consequence of omnipotence; split of primitive idealization
Displacement: Directing an impulse, wish, or feeling toward a person or situation not its real object, thus permitting expression in a less threatening situation
Ethical Decision Making: Understanding legal duties
Understanding values/ethics of Social Work
Identifying legal and ethical implications
Logical ethical decision making process
HMO: Health Maintenance Organization
Hollis Typology of Categories of Interventions---Direct: Client-Social Worker Communication: EGO SUPPORTIVE
1. Sustainment
2. Direct influence
3. Exploration, description, ventilation

EGO MODIFYING
4. Person in situation reflection, including self evaluation
5. Pattern-dynamic reflection
6. Developmental reflection
Hollis Typology of Categories of Interventions---Indirect: Environment Interventions: EGO SUSTAINING
1. Resource development or provider of services
2. Interpreter of or mediator between client and environment
3. Intervene in the environment
Idealization: Overestimation of admired aspect or attribute of another
Identification: Universal mechanism whereby a person patterns self after significant other
Independent variable: Treatment intervention
Intervening variable: Generally will be "meds" on test
Isolation of Affect: Unacceptable impulse, idea, or act is separated from its original memory source, thereby removing original emotional charge
Medically necessary: Condition must be determined to be "medically necessary" in order for there to be reimbursement
Mood Stabilizers (anti-depressants): Elavil
Celexa
Wellbutrin
Remeron
Norpramin
Effexor
Prozac
Serazone
Tofranil (imipramine)
Zoloft
Lithium (adults) Depakote (adolescents): used with Bipolar manic phase, sometimes in conjunction with an anti-depressant
Non-network provider: Out of network provider; usually reimbursed at a lower rate but fewer accountability requirements
OCD Meds: SSRI Anti-depressants, particularly Zoloft and Paxil
Other Therapeutic Communication Skills: Empathy
Centering
Confronting
Reframing
Advising
Educating
Focusing
Reviewing
Reflecting
Interpreting
POS: Point of Service; usually refers to a type of managed care contract
PPO: Preferred Provider Organization
Preapproval/Precertification: Approval to provide service; based on a determination of "medical necessity" by case manager
Primary Care Physician: The physician who serves as the gatekeeper; all non-routine care must come through the PCP
Primary Process Thinking: 1. Disregards logical connections between ideas
2. Permits contradictions to exist simultaneously
3. Lacks concept of time
4. Wishes are represented as fulfillment
Projection: Primitive defense; attributing one's own disowned attitudes, wishes, or feelings to an external object
Reaction formation: Person adopts affects, ideas, attitudes, or behaviors which are opposite of those he harbors consciously or unconsciously
Reality testing: Accurate perception of external environment and internal world
Regression: Partial or symbolic return to more infantile patterns of reacting or thinking; can be in service to the ego
Roleplaying: Acting out the parts of important characters to dramatize feelings and practice new ways of relating
Scapegoat: A member of the family, usually the identified patient, who is the object of displaced conflict or criticism
Schemata: Action sequence and behavior patterns; organization and adaptation
Secondary Process Thinking: 1. Follows reality principle
2. Postpones gratification
3. Replaces wish fulfillment with appropriate action on the environment
4. Goal directed
Sedatives (Anti-anxiety agents): Xanax
Librium
BuSpar
Ativan
Valium (Diazapam)
Klonapin (Benzodiazine)
Inderal
Restoril
Self Awareness and Self Understanding: Understanding the influence of family of origin
Understanding the influence of current situational factors
Assessing one's self esteem
Assessing one's acceptance of others
Assessing one's assertiveness
Assessing readiness for social work practice
Splitting: Defensive mechanism of borderline personality organization which manifests as self or others being seen as all good or all bad.
Stimulant (ADHD) Meds: Ritalin
Dexidrine
Cylert
Talking and Listening Basic Interpersonal Skills: Voice and speech
Body language
Listening: hearing, observing, encouraging and remembering
Active listening
General Systems Theory: Based on the concept of a system as interacting parts contained within a boundary (family system unit)
Homeostasis: Steady state order necessary for movement
Feedback: When output from systems is put back into the system
General Systems Theory: Implications for Practice: 1. Problems are defined in transactional terms
2. The unit of attention includes the relevant related systems
3. Humans are active, purposeful, goal-seeking organisms whose development and functioning are outcomes of transactions between their genetic potential and their environment
Adaptedness: Goodness of fit with the environment; this is a continuous process
Stress: Environmental demand perceived as challenge and associated with positive feelings or discrepency between demand and capacity for coping with it associated negative feelings
Coping: Psychological, physiological and behavioral response that is set in motion as result of the experience of emotional stress.
Fixation: A point of development where there is a failure to resolve conflict
Psychoanalytic Treatment Goal: To resolve intrapsychic conflict; treatment involves dealing with the repressed material in the unconscious using clarification, confrontation, interpretation, and working through
Psychoanalytic Theory: Individual is viewed as a product of his past
Ego Psychology (Erikson): Personality develops as a result of interaction with and mastery of the social environment with a progressive development throughout the life cycle.
Ego Psychology Treatment: Geared to enhancing the effective and efficient functioning of the ego in managing internal and external stress
Object Relations Theory (Mahler): A development of a consolidated sense of self as the result of separation and individuation of the self from the love object (mother).
Object Relations Substages: Attachment
Separation
Individuation
Object Constancy
Object Relations Treatment: Geared to enhancing the self-object differentiation
Moral Development Theory (Kohlberg): Parallels cognitive development in that the child cannot achieve higher levels of moral reasoning until achieving higher levels of cognitive reasoning; can have cognitive without moral, but cannot have moral without cognitive
Pre-conventional: Moral reasoning based on avoiding punishment and to serve one's own needs
Conventional: Moral reasoning based on the need to look good in one's own eyes and the eyes of others
Post-conventional: Belief in greater moral principles and a sense of personal commitment to doing what is right, regardless of individual needs.
Stages of Death and Dying (Kubler-Ross): Denial
Anger
Bargaining
Depression
Acceptance
Social Role Theory (Basic Themes): 1. Certain behaviors are prescribed relative to our position in that system.
2. Every role involves both our own expectations and abilities as well as the expectations of others
3. Social functioning may be seen as the sum of roles performed by the human system
4. The concept of role, role functioning, role expectations, and role transactions may be used to increase the knowledge base for the assessment of the problem situation
Role Ambiguity: Role expectations are unclear
Role Conflict: 2 or more opposing views on role definition
Role reversal: Roles are opposite to that which previously existed
Locus of control: the extent to which an individual believes that life events are under his own control (internal locus of control) or under the control of external forces (external locus of control)
Social Authority or Power: Coercive: power from control of punishments
Reward: power from control of rewards
Expert: power from superior ability or knowledge
Legitimate: power from having legitimate authority
Three Basic Assumptions of Communication Theory: 1. One cannot NOT communicate
2. All human communication is multi-leveled
3. The message sent is not necessarily the message received
Contradictory communication: Offering 2 or more contradictory messages on the same communication level
Incongruent communication: Offering 2 or more contradictory messages on different communication levels
Ambiguous communication: Verbal and nonverbal communication do not give the receiver adequate information upon which to formulate an adequate response
Paradoxical communication: Giving one message and acting out another
Stimulus-response dilemma: Communication based on the premise that one is simply being reactive to the other therefore is not fully responsible for the communication
Overload at the content level: Too much information provided at one time or the information sent cannot be responded to appropriately because of the split content
Problem Solving Approach (Perlman) MAIN MODEL OF THE SOCIAL WORK PROFESSION: Based on the assumption that all human living is a problem-solving process. An inability to cope is due to some lack of motivation, capacity or opportunity to solve problems in an appropriate way. Treatment is reality based.
Treatment Actions in the Problem Solving Approach: 1. To release, energize and give direction to the client's motivation.
2. To release and then repeatedly exercise the client's mental, emotion and action capacities for coping with his problem and/or himself in connection with it
3. To make accessible to the client the opportunities and resources necessary to the solution of the problem
Problem Solving Approach Looks at the 4 P's in the process of change: Person
Problem
Place (agency)
Process (therapeutic relationship)
Psychosocial Approach (Hollis): People are seen in the context of interactions or transactions with the external world. A formal medical, psychological and social history are obtained, and the diagnosis is based on this history.
Psychosocial Treatment: Differentiated according to needs of clients and results in a modification of the person, environment, or both, and of the exchange between them. Uses all developmental theories and integrates various aspects of all relevant treatment modalities.
Crisis Intervention (Golan): Process of actively influencing the psychosocial functioning of individuals during a period of disequilibrium. A state of crisis is time limited (usually 6-8 weeks). Brief intervention during a crisis usually provides maximum therapeutic effect. Social Worker is active rather quickly
Crisis: An upset in a steady state. Crisis is defined by the client. Feelings of hopelessness may be present and ego patterns may be more open to influence and correction.
Goals of Crisis Intervention: 1. Relieve impact of stress with emotional/social resources
2. Return to previous level of functioning
3. Help people strengthen coping mechanisms during the crisis period and develop adaptive coping strategies
Brief and Planned Short Term Treatment: Restricts duration to 8-12 sessions
Uses interventions from learning theory and behavioral modification to promote completion of a well-defined task
Primary aim is to quickly engage clients in the problem-solving process and maximize their responsibility for treatment outcome
Task-Centered Treatment: Offers a pragmatic approach in which the problem is partialized into clearly delineated tasks to be addressed consecutively.
Client must be able to acknowledge a precise psychosocial problem, the solution to which is either a specific change in behavior or a change of circumstances.
Assessment focuses on helping client identify the problem that is of primary concern; circumstances surrounding the problem are explored and specific tasks evolve from this process.
1. Assessment
2. Set goals
3. Define tasks
Time-limited Psychotherapy: Addresses the client's emotional reactions to a strictly time-limited process that makes optimal use of the role of the "doctor-patient" relationship. Uses a non-negotiable time-limited contract.
Behavioral Approaches: 1. Goal is to modify behavior
2. Focus is on observable behavior
Respondent or Classical Conditioning (Pavlov): Learning occurs as a result of pairing a stimulus with an involuntary response so that the stimulus eventually elicits the conditioned response
Operant Conditioning (Skinner): Antecedent events precede behaviors which, in turn, are followed by consequences. Consequences which increase the occurences of the behavior are referred to as reinforcing; consequences which decrease the occurence of the behavior are referred to as punishing.
Systematic desensitization: Anxiety-producing stimulus is paired with relaxing response so that eventually anxiety-producing stimulus produces a relaxation response.
In vivo desensitization: Pairing and movement through hierarchy takes place in "real" setting
Aversion Therapy: Any treatment aimed at reducing the attractiveness of a stimulus or a behavior by repeatedly pairing it with aversive stimulation of a real or imagined nature
Sensate focus: An in vivo desensitization and communication-enhancement procedure used in sex therapy that involves the couple providing each other with pleasurable sensory stimulation through a structured body message (pleasuring)
Squeeze technique: A procedure for delaying ejaculation
Positive reinforcement: The worker praises, gives tokens, or otherwise rewards positive behaviors
Negative reinforcement: Behavior increases because negative (aversive) stimulus is removed
Fading: A procedure for gradually changing one stimulus controlling a behavior to another stimulus
Cognitive Approach: Human functioning is seen as the product of reciprocal interaction between personal and environmental variables.
Emphasis is placed on cognitive skills from problem solving.
What a client says to himself influences his behavior and feelings.
Certain thoughts cause certain behaviors and certain behaviors cause certain thoughts.
Cognitive Treatment: 1. Gaining understanding of, and communicating from, the client's system of meanings.
2. Initially accepting the "internal validity" of the client's personal views and understanding what maintains them.
3. Gradually facilitating the client's ability to consider other possible meanings by putting the same facts or situations into other conceptual or emotional frameworks
4. Building client awareness of the possible inaccuracies of their cognitive appraisals
5. Focusing the attention on client's expectations and interpretations of events.
6. Helping the client construct alternatives, more adaptive meanings, expectations, and self instructions
7. Providing experiences that give evidence to support changed views and counter old ones (task assignments and behavioral experiments)
Rational Emotive Therapy (RET): A cognitively-oriented therapy in which the therapist seeks to change the client's irrational beliefs by argument, persuasion, and rational re-evaluation, and by teaching the client to counter self-defeating thinking with new, non-distressing self statements.
Gestalt: Experiences are not isolated but are part of a perceptual system of interdependent factors
Gestalt Treatment: Experiential
Here and now
Often used with groups as well as individuals
Family Therapy: Views the family as a system of interacting parts in which change in any part affects the functioning of the whole. The family is the unit of attention for diagnosis and treatment. Social roles and interpersonal interaction are the focus. Real behaviors and communication that affect the current life situation are emphasized
Goal of Family Therapy: To interrupt the circular feedback of pathological communication and behaviors, then replace it with a new pattern that will sustain itself without the dysfunctional aspects of the original pattern
Issues in Family Therapy: Establishing a contract with the family
Examining alliances and groupings within the family
Where the power resides
Relationship of each family member to problem
How does the family relate to outside world
Family history as related to interaction in current behavior
Communication patterns: complementarity, symmetrical
Family rules that regulate patterns of interaction
Meaning of presenting symptom in current family homeostasis
Flexibility of structure and accessibility of alternative action patterns
Family's development stage
Sources of external stress and support
Family homeostasis
Interventions in Family Therapy: Define family stages and tasks
Address emotional cutoff
De-triangulation
Coaching
Redefine family rules
Genogram
Restructuring roles
Structural Family Therapy (Minuchin): Stresses the importance of family organization for the functioning of the group and the well-being of its members.
Family Structure: The invisible set of functional demands organizing interaction among family members.
Multi-generational Approach (Bowen): Pathology in current family relationships is seen as unfinished business in family of origin relationships. Problems are fusion among family members and inadequate individuation
Goal of Multi-Generational Approach: To increase differentiation of individuals within the family and avoid the need for triangulation
Strategic Family Therapy (Haley/Palo Alto Group): Presenting problem is viewed as a symptom of and a response to current dysfunction in family interaction.
Goal of Strategic Family Therapy: To solve the particular problem that is presented. The symptom is regarded as a communicative act that is part of a repetitive sequence of behaviors among family members, serving a function in the interactional network.
What does Strategic Family Therapy focus on?: Problem resolution by altering the feedback cycle that maintains the symptomatic behavior
What is the worker's task in Strategic Family Therapy?: To formulate the problem in solvable, behavioral terms and to design an intervention plan to change the dysfunctional family pattern.
Psychodrama: A treatment approach in which roles are enacted in a group context. Members of the group recreate their problems in living and devote themselves to the role dilemmas of each member.
Group Psychotherapy: Treatment of patients with mental illness: uncovering procedures, the achievement of insight into unconscious motivations, and other intrapsychic processes.
Stages of Group Development: Pre-affiliation (Forming): development of trust
Power and control (Storming): struggle for individual autonomy and group identification
Intimacy (Norming): utilizing self in service of the group
Differentiation (Performing): acceptance of each other as distinct individuals
Separation/termination (Adjourning): independence
Factors in Group Cohesion: Group size: optimal 5-10
Homogeneity: similarity of group members
Participation in goal and norm setting for group
Interdependence: dependent on one another for achievement of common goals
External threat: increases cohesiveness
Member stability: frequent changes in membership decreases cohesiveness
Contra-indications for group treatment: Client in crisis
Compulsive need for attention
Actively psychotic
Paranoid
Suicidal
Primary Prevention: To prevent: aimed at reducing the prevalence of a problem by reducing the incidence of new cases; creating environments that promote mental health
Secondary Prevention: To treat symptoms: reduce prevalence by reducing the duration through early detection and intervention
Tertiary Prevention: To reduce disability in chronic problems: reduce duration of problem by reducing negative after effects

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Number of cards 156