Aswb Exam Clinician

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Development Theories (1)

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1. Freedom VS. Determinism - people have control v. behavior is determined.
2. Nature v. Nuture - genetics v. environment
3. Unique v. Universality - people are unique v. people are similar.

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Development Theories (2)

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4. Active V. Reactive - people are on own v. react to other stimulus
5. Optimistic v. Pessimistic - people can change v. people cannot change

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Development Theories (3)

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6. Physiological v. Purposive - people are pushed by physical needs v. pushed by goals, values, etc.
7. Conscious v. unconscious - people are aware v. unaware of their motivation

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Development Theories (4)

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8. Stage v. non-stage - people do vs. do no go through stages of development
9. Cultural determinism v. Cultural Transcendence - people are molded by culture v. not molded

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Development Theories (5)

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10. Early v. Late Personality - develop personality early and remained fixed v continue to develop personality.

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Psychoanalytic Theory

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Founded by Freud. Viewed behavior as unconscious drives and motivation rather than actions and thoughts. Behavior and thoughts are driven by unconscious forces. The person acts on dreams, wishes, and desires. All behaviors serves some purpose. Focus on past. Shaped by repressed childhood memories. Personality is shaped by age 5.

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Driving Forces

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development of mental state is result of reciprocal exchange between two forces, urging force and checking force

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Cathexis

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urging force. Force that drives desire

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Anti-Cathexis

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Checking force. Acts as breaks on imprudent actions.

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ID

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Most primitive portion of personality. Basic drives including sexual. Require immediate gratification. Children are born with just ID. Act only to seek pleasure and avoid pain.

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Ego

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need for immediate gratification is delayed. Mediate between demands of individual and demands of environment. Includes Relay Principle - helps people understand they can't have immediate gratification

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Superego

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allows people to act out of need and to consider moral and ethical aspects. 2 aspects: conscience which contains should nots and ego ideal which contains the shoulds.

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General info on Psychosexual Stages of Development

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Personality develops as a result of 2 events, (1) maturation and natural growth, (2) learning to overcome frustration, avoid pain and conflict. To move through stages have to have resolution of conflict from earlier stage.

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Regression

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gratification is too frustrating so person may return to earlier psychosexual stage.

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Oedipus complex

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During phallic phase boy becomes jealous of father and competes for mother attention. Boy fears father will remove offending sex organ (castration theory). At end of phallic stage develop superego, and complex is resolved.

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Electra complex

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Girl between ages of 3-7 develops unconscious sexual attraction for father. Realizes she has no male sex organs and blames her mother.

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Stages of Psychosexual Development

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Oral, Anal, Phallic, Latency, Genital

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Oral

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0-1.5 years - experiences world and derives pleasure from stimulus of mouth.

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Anal

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1.5 to 3 - focuses on anal region and gains control over sphincter and bowel.

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Phallic

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3-6 - pleasure moves from anus to genitals

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Latency

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6-12 - focus on genital and sexuality develops into more socially acceptable behavior.

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Genital

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12-Adult - accepts genetalia and begins to experience mature, adult sexual feelings.

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Defense Mechanisms - General

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Developed by Anna Freud - When ego senses certain act may cause harm Ego produces anxiety. Caused defense mechanism to help.

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Defense Mechanisms (1)

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Denial - refusing to acknowledge reality
Displacement - shifting feelings to another object
Dissociation - separation of feeling that would normally accompany situation.
Idealization

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Defense Mechanisms (2)

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Identification - modeling one self upon another person.
Introjection - id'ing so much you become part of it
Inversion - refocusing emotions from event onto oneself
Isolation- cannot experience cog, and affective components of situation.

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Defense Mechanisms (3)

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Intellectualization
Projection
Rationalization
Reaction formation - replacing negative even with opposite.

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Defense Mechanisms (4)

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Regression
Repression
Somatization - emotional anxiety that turns into physical symptoms

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Defense Mechanisms (5)

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Splitting - Repressing or disconnecting important feelings that are dangerous
Substitution - replacing one feeling with another

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Ego Psychology

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Focuses on process of adaptation which is reciprocal relationship b/wn individual and their environment. Which involves changing the environment. All human behavior is result of people adapting. All people born to adapt but to continue need ego.

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Alloplastic and Autoplastic

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Allo-changing one's environment to adapt.
Auto - changing one's behavior to adapt.

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Ego Functions (1)

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Reality testing
Judgement - ability to ID consequences of behavior
Sense of Reality - able to perceive and experience things rationally
Regulation and control of drives and impulses

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Ego Function (2)

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Object Relations - ability to interact with others
Thought Processes-ability to have realistic thoughts
Adaptive Regression - ability to let go of reality and experience inaccessible aspects of self

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Ego Function (3)

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Defensive Functioning - use unconscious mechanisms to reduce anxiety
Stimulus barrier-able to maintain function with stimulus
Autonomous Function - function that are able to function continuously

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Ego Function (4)

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Mastery Competence - Can successfully interact with environment
Integrative functioning - able to integrate parts of personality to resolve conflict

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Psychosocial Theory

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Erik Erikson. Social environment shapes behavior and personality. Entire lifespan. Emphasizes ability for person to change persona.. Ego is most important part of personality. Person. continues to develop past 5. All people are innately worthy. All can adapt. Psychological system is important determinant of behavior but can't discount social and biological systems.

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8 stages of psychosocial developement general info.

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Each stage focus on 1 area of growth and needed for stages b4 and after. Marked by crisis which must be resolved by ego. Each stage marked by conflict btwn systonic and dystonic which are personality traits. Must be balanced with tendency towards systonic.

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8 stages of development

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Trust v. mistrust/autonomy v. shame and doubt/initiative v guilt/industry v. inferiority/identity v. role confusion/intimacy v. isolation/generativity v. stagnation/ego integrity v. despair.

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Trust v. Mistrust

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Birth to 1 year. develops a sense of trust through being nurtured and loved if no love then there will be mistrust which will cause child to withdraw.

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Autonomy v. shame and doubt

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2 to 3 years. develop skills to become autonomous so become confident. If not given what is needed they will feel ashamed and less confident.

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Initiative v. Guilt

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4 to 5 years - Child becomes curious and exploresz and learns to play with others. If not allowed they will feel guilty and fearful.

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Industry v. Inferiority

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6 to 11 years-develops need to do things well, to work and provide in future. School and peers are critical to help child master tasks. If not achieved child will feel inferior and incompetent.

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Identity v. Role Confusion

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12-18 years - Adolescent creates their own identity and integrate components of themselves into whole person. If not able to integrate will experience role confusion

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Intimacy v. Isolation

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20-35 years - Learns to build reciprocal relation with others on many level. If people fail to do so they will be isolated.

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Generativity v. Stagnation

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35-50 years - develops capacity to care and nurture. If they fail they will only care for themselves

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Ego Integrity v. Despair

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50 plus years - individual learns to accept their own life achievements and significant others. If fail they will experience despair.

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Biopsychosocial Theory (1)

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Human behavior is result of interactions b/wn biological, psychological, and social systems. They all must interact. Systems and ecological systems theory plays a role. Also general systems theory and life model and ecosystems approach.

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Biopsychosocial Theory (2)

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We come into this world with inherited dispositions, they interact with environment and produce patterns of behavior and adaptation. Who we are at any given moment is the result of intertwining of constitution, consciousness, and context/environmental elements.

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Temperament

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Basic pattern of reaction to the world (neuro-phsy., emotional, cognitive, and behavioral reaction). 2 types inhibited and uninhibited. Inhib. person borth with sensitivity, high arousal and distress. Uninhib. much more unfazed by stimuli, assertivenes and fearlessness

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Empowerment

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Defined as helping other see the wisdom and strength w/in and around, and to use those resources. It requires: the belief and hope in others, respect for innate wisdom of others, willingness to collaborate with others, dedication to helping

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Object Relations Theory

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Bowlby, Mahler, Spitz. Focuses on reciprocal relation b/wn mom and infant and how it effects infant sense of self. Indiv. are born w/drive to develop a sense of self and other as well as wanting to build relations. Sense of self affects all other relations. Way childs ego becomes org. over first 35 years.

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3 Stages of Object Relations Theory

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Autistic
Symbiotic
Differentiation/Practicing/Reapprochment/Object Constancy

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Autistic

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Newborn to one month - infant focused purely on self/unresponsive to stimuli.

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Symbiotic

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1-5 months - percieve the "need-satifying object" mother's ego function for infant. Begins to understand mom as separate.

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Differentiation

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5-9 monhts. infants attention shifts from being inward focused to outward focused. Begin to separate from mom.

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Practicing

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9-14 months - continues to separate and autonomous ego functions become more apparent, becomes more mobile.

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Reapprochment

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14-24 months - want to act independent. Moves away but does check to ensure mom is still there.

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Object Constancy

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Understands mom still exists even when not there

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Attachment Theory (1)

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Bowlby - emotional bond to another person. Earliest bonds have big impact on their lives and develop through life span. Biological basis as well to keep infant close to mom. If child is attached they will trust others and feel secure.

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Attachment Theory (2)

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Attachment should be a safe haven so child feels like they can return when scared. Should have secure base to allow child to explore. Should have proximity maintenance so they strive to be near mom.

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Secure Attachment

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exhibit distress when separated from caregivers and happy when return. Feel secure and able to depend on caregiver. Know parent will return.

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Ambivalent Attachment

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become very distressed when parent leaves. Uncommon. Happens with 7-15 percent of kids. Result of poor maternal availability.

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Avoidant Attachment

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Avoid parents and when given choice child will show no preference b/wn parent and stranger. Fail to form attach can have neg. impact on behavior and adult relationships.

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Analytical Pyschology (1)

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a.k.a Jungian psych-originated from Jung. Emphasizes conscious and unconscious influence on behavior. Believes Ego is conscious. Communication b/wn conscious and unconscious in critical.

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Analytical Psychology (2)

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Dreams are the known but unknown, contained unconscious and show things people to be aware of. Collective unconscious contains archetypes common to all humans. 5 archetypes

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Self

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Regulating center of pyche and facil. of individual

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Shadow

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unconscious complex defined as repressed, suppressed or disowned qualities of conscious.

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Anima

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Feminine image in man's psyche

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Animus

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masculine image in woman's psyche

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Persona

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how we present to the world. All people are intro and extrovert but one is more dominant.

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Cognitive Theory

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Individ. cognition and thoughts are primary determinants of behavior (Adler, Ellis, and Beck). Ind. emotions and behaviors are direct results of cog. Personality is flex. can be influenced by other factors. People can change environ.

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Differences b/wn Cognitive Theory and Freud's Theory

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Personality should be viewed as a whole not separate (like, id, ego). Behavior is driven by social motivation not sexual drive. An indiv. conscious thoughts and beliefs are of much greater importance.

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Rational Emotive Therapy

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Ellis. ABC theory of emotion. A represents activating event, B represent thoughts/beliefs about A and C represents emotional and behav. consequences. When person has irrational thoughts they are disturbed or dysfunctional

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Self Psychology (1)

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Kohut. Acknowledged the interrelationship b/wn social structure and personality development. Infants instinctual drives separate from attainment of a cohesive self. Child. born into empathetic environ. comprised of self objects.

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Self Object

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Childs perception of other people and objects as part of self. The self and self object relation is central to psychological functioning and not self object relations.

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Narcissism

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Integral part of normal and abnormal develop. 2 forms one for self and one for objects. Abbnormal narcissism occurs when child is deprived of empathetic environment. They can't turn into realistic and healthy self w/o mirroring.

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Empathetic Mirroring

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process by which self object (mother) mirrors the child. It reflects to the child that the self object hears and understands the child need. This helps the child develop self identity and form cohesive self

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Transmuting Internalization

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process in which a person contains a cohesive self by transforming positive healthy object in internalized self-structure. Occurs during first few years of life.

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Gestalt Psychology (1)

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Peris. focuses on holistic nature of human experience. The total person. Focuses on present and believes that behaviors are conscious and can be controlled. Person is whole. Issues and problems are viewed as part of experience.

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Gestalt Psychology (2)

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Personality develop. varies for each person. Personality consists of integrated parts that make a whole. Focus on present but past can influence. Must view the total individuals experience including environment.

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Lifespan Development Theories

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Focus on individuals mastery of certain skills and tasks and describe it in terms of stages of development. Seek to delineate human development and designate approx. ages which individuals begin and end a certain stage.

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Piaget's theory of cognitive development

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Human behavior and development were the product of certain patterns of interaction called schemas. All people have schemas. They are sensorimotor and cognitive.

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Schema

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goal oriented strategies that people use to explore the environment and learn more about the world

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Adaption

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The reciprocal exchange between individuals and environment

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Assimilation

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The incorporation of an aspect of one's environment.

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Accomodation

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Adaption of modification of existing mental organization or thought to characteristics of a new object.

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Sensorimotor Stage

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Birth to 2 years. Infant uses senses and motor functions to understand world. Form circular reactions (this feels good, do again). Unable to have symbolic functions

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Pre-operational Stage

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2-7 years. Child uses symbols. Learns to talk. Can understand past and future. Very self-centered.

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Concrete Operational

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7-11 years. Manipulate symbols logically. Also conservation of substance (if you separate clay there is still the same amount.)

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Formal Operational

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11-15 years. Child learns more adult like thinking. Goes from logical operation thinking to abstract thinking, a.k.a. hypothetical thinking.

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Kohlberg's Theory of Moral Development

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Agrees that moral development occurred in successive stages, but that it was longer and more complex. Moral development is learned from family. Moral behavior develops due to intelligence and ability to interact. Very few people reach level 5. No one has reached 6,

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Pre-Conventional

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Stage 1 begins at school age. Behave according to socially acceptable norms to avoid punishment. Stage 2 - Indiv. acts out of best interest.

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Conventional

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Stage 2 person behaves to gain approval. Stage 4 behaves in accordance with laws and rules.

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Post-Conventional

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Stage 5 - gain a genuine interest in others and understand social mutuality. Stage 6-highest moral stage when individual develops autonomous morality based on individual conscious.

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Physical, Mental and Cognitive Disabilities

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A condition or function judged to be signific. challenging compared to standard experience. Multidimensional experience. 3 dimensions of disability 1. impairment in body structures, 2. activity restrictions, 3. participation restrictions. Can be mild, moderate or severe

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Respondent or Classical Conditioning Theory

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Process by which individ. learns a behavior through assoc. A satisfying stimulus is paired w/ neutral stimulus to produce behavior. Pavlov. Behaviors are response of some environmental event stimulus. Can be voluntary or involuntary.

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Operant Conditioning

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Skinner. Changes in behave. are the result of changes in the environ. All behaviors can be elicited through reinforcement. Frequency of behavior is increased or decreased by positive or neg. reinforcement.

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Punishment

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THe presentation of an unpleasant or undesired event following a behavior to decrease the occurance of that behavior. Reinforcers want to increase behavior

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Social Learning Theory

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Bandura. All behaviors are learned and can be changed by altering the events that occur after behavior. ABC. A is antecedent-environ. even that occurs b4 behavior. B is behavior so focus and target for change. Consequence is event that occurs after behavior.

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Existentialism

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Humanistic perspective. Emphasizes individ. autonomy and the ct's right to self-determination. We are defined by our freedom to make choices and discover creative meanings for ourselves. No standard human nature. Self is ongoing process

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4 sources of alienation

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Failure of confirmation by SO. Deception over value conflicts. Disillusionment, confusion, or loss of personal values. Loss of SO. Anguish and dread are viewed at negative feelings that arise from experiences of freedom and responsibility.

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Provocative Contact

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Ct. wants no help so it must be forced

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Sustaining Relationship

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Ct. sees no hope for change so remains lonely and doesn't try to understand past relations.

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Specific behavior/symptom change

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Ct. seeks help for behavior but can't relate it to other aspects. Sees actions as unchangeable

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Environmental Change

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Recognizes that suffering is associated with environmental forces. Hopes for change outside himself. Feels oppressed by others with power.

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Relationship Change

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realizes SO are important but dissatisfied with SO

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Directional Change

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(personalizing values). Ct's sense of life direction is shaken, values are confused. Sense of freedom weakened.

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Insightful Analysis

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Client wants to understand personal analysis. Client works to understand themselves.

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Family Systems Theory

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Bowen. Multigenerational. Emotional ties influence the lives of individ. Family consists of subsystems and boundaries. SS are groupings w/in family. Person can be part of different SS.

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Boundaries

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The rules as to who participates in activities and how. To be healthy you must balance emotion and reason. If you do so effectively it is known as differentiation. If you have not achieved that you are enmeshed (being overly connected to other family members). Opposite in disengaged

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Group Projective Identification

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Assign roles to fulfill family needs. Individ. and family respond to life in interactional patterns/boundaries which are formed to control movement of info, people, and objects in and out of systems.

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Roles

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Closely aligned. Some are temp only as long as person wants to serve in the role. Some are perm but may change via human development. Each member has roles that either lead to function or dysfunction. Child may assume dysfunc. Must view family as total system.

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Triangles (1)

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Primary unit of analysis is interpersonal triangle. All relationships are unstable so need 3rd party to make stable. When in conflict rely on 3rd person for mediation. Alliances always shifting. Problems can happen.

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6 stages of triangles

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Young Adult/young couple/family with young child/family with adolescent/ family at midlife/ family later life. Family will either progress or get stuck at each stage.

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Emotional Fusion

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members distance themselves in order to reduce the intensity of relation. Become isolated

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Psych Defenses

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keep unacceptable impulse out of awareness

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Emotional cutoff

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process between generations where people separate themselves from past.

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Societal Emotional Process

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social system can be conceptualized as analogous to those of family regarding rules that govern interpersonal behavior within and among them

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Detriangulation

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therapist disrupts triangle

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Homeostasis

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biological system maintains relatively stable internal environment through interaction of numerous processes. Families want equilibrium.

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Birth Order

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Adler. Ordinal position sums up differences in age, size, power, and privilege. Siblings compete to secure physical, emotional, and intellectual resources.

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First Born

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Identifies with parents and authority, conforming, ambitious, defensive, aggressive, traumatized after 2nd child so become surrogate, be responsible, intelligent, and emotionally intense.

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Second Born

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Cannot endure strict leadership, cooperating, pleading, and whining. Question authority. Don't want to be compared

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Last born

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More inclined toward sociability, lazy, spoiled, feel inferior, altruistic, more liberal.

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Common Characteristics of Abusive Parents

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low self-esteem, unworthiness, repeated loss and rejection, dysfunctional childhood, being thrust in foreign environment, isolation, lack of support system, feed need to control, financial stress, anxiety, depression, limited education.

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5 tasks abusive parents may not have learned

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1. how to get needs met in appropriate ways. 2. How to separate feelings from actions. 3. How to determine they are responsible for own actions, not actions of others. 4. How to make decisions. 5. How to delay gratification.

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Children Rights

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Enjoyment of rights w/o exception to race, sex, etc. Special protection and opportunity to help them develop. A name. Social Security: Adequate nutrition, housing and medical. Special services if handicapped. Love, understanding affection. Fee education. Prompt protection

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Child Neglect

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Is an act of omission rather than assault. 3 main categories: physical, educational and emotional.

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5 types of neglectful parents

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Apathetic-have given up on living, 2. Impulse-ridden - no tolerance for frustration, poor judgement. 3. Mentally retarded. 4. Depressed - unable to adjust. 5. Borderline or psychotic.

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Effects of Neglect on Children

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Difficulty building trust, delayed closeness development, higher levels of anxiety, difficulty at school, risk to become neglectful, develop disorders, difficulty relating sexually, distorted views on sex or bad behavior...

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Child Physical Abuse

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Non-accidental injury. Can depend on cultural. Statistics are only estimates. More likely to happen if child is born out of wedlock, premature, malformed, conceived in bad situation

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Causes of Physical Abuse

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Psychopathological - characteristic of abusers as primary cause-psychodynamic, mental illness, character trait. Interactional - dysfunctional family system as primary cause. Environmental-Sociological-Cultural-view stressors from environ. society, or culture as cause of abuse.

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Family Crisis

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Crucial pt. in family where conflict reaches its highest tension and must be resolved.

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3 Phases of Family Crisis

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1. The event before the crisis. 2. The period of disorganization. 3. Reorganizing or recovery phase. After crisis hits bottom family can recover. Crisis meeting capabilities (resource and coping) demonstrate family ability to prevent stressor from disrupting unit.

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Family Stress Model

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ABC-X. A is stressor, B. is family mgmt. strategies, coping skills. C. is family perception of situation and X is family adaptation to event. The double ABC-X model is used to describe pile up concept of stressor overload. Better coping strategies mean better response from family.

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Movements influential to child sex abuse

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Child Protection Movement-works primarily with family to protect child. Feminist - Societal issue, women and children are inferior.

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Phases of Child Sexual Abuse

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A. Engagement - gains access and convinces child behavior is acceptable(groming) B.Pressured Sex-persuasion, child feels oblig. bribery. C. Forced Sex - thread of harm, may not intend hurt but does. D. Sexual Interaction and Secrecy E. Diclosure. F. Suppression

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Child Emotional/Psychological Abuse

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Must be ongoing pattern. Could be rejecting, isolating, etc. Leads to feeling of isolation and inadequacy. Respond by fighting back or turning anger inward.

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Reasons for emotional/psychological abuse

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Parents who have unwanted pregnancy or unreasonable expectations, parents with unmet childhood needs, alcohol/drug problem, divorce or separation, mental illness, teen parents.

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Biological Aspects of Aging

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Structural: loss of muscle mass and tone, flattering of cushion b/wn vertebra, Fragile bones. Taste buds change. Changes in mouth, weakness. Heart weakens, BP increases, slower breathing, enlargement of prostate, teeth more brittle.

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Psychological Aspects of Aging

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Short term memory declines, long term memory improves, more resistant to change due to need to maintain control, or not understanding. Tells stories

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Medical Concerns of the Aging

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Osteoporosis, dementia, Parkinson's disease, Alzheimers, Depression, Multiple Sclerosis. Lou Gehrig's. Heart disease, cancer.

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Anti-Psychotics

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Prescribed for psychosis-schizo, mania, depression with hallucinations as well as degenerative diseases (Dementia). Blocks the action of neurotrans. to help pt. calm down and focus. Ex. Haldon, Mellaril, Novene, Stelagine, Trilafon, Loxitane, Thoroine. Sedation, dry mouth, tremors, etc.

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Anti-Anxiety Meds

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For disabling anxiety, panic attacks, and phobia. PTSD. Alcohol withdrawal. Xanax, valium, ativan, buspar, librium. Sedation, dry mouth, nausea, dizziness, etc. They are safe and used on short term basis

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Anti-Depressants

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For depression that lasts more than 2 weeks, panic attacks, and OCD. Prozac, Zoloft, Wellbuitrin, Pamelor, Sinequin, Vivactil, Elavil, Paxil.

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Basic Principles of Adult Productive Services

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Self-determination. Treat cts with honesty, care, and respect. The least restrictive. Least amount of disruption. Highest priority to family and support system. Protection is community responsibility. Need for protective services. Right to privacy and confidentiality.

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Competency

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The legal status of being able to make decisions for yourself.

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Capacity

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Medical determination. Generally refers to if a person can complete ADL's, and should be eval'd throughout entire eval. Degrees of capacity based on intensity, duration, and frequency. Assess using ADL and IADL, mental status exam, and capacity screening assess.

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Palliative Care

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Service that seeks to prevent or relieve pain, physical, psychosocial, or spiritual quality of life. Conditions can be life limiting (terminal) or chronic.

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Hospice

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A form of palliative care focusing on support and physical comfort at end of life. 6 months or less to live.

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10 Standards for Cultural Competence

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Ethics and Values, Self Awareness, Cross-Cultural Knowledge, Cross-Cultural Skills, Service Delievery, Empowerment or Advocacy, Diverse Workforce, Professional Education, Language Diversity, Cross-Cultural Leadership.

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Prejudice

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feelings or thoughts about minority groups based upon perceived values, normative judgement, etc.

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Discrimination

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Act or behavior of expressing prejudice; the intentional taking away of choices, benefits.

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Critical Multiculturalism

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Theoretical stance that is compatible with the values of social work. Enhances diversity.

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Social Stratification

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placement of different groups within society.

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4 minority group classifications

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Race, gender, sexual orientation, and age

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5 Major racial/ethnic groups

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Asian, Black, Hispanic, Native American, and White

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Exploitation

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Products of 1 groups labor are transferred to benefit a more privileged group.

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Marginalization

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groups of people are denied the opportunity to participate in social life and are subjected to severe deprivation.

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Powerlessness

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Marginalized groups lack authority, status, etc.

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Cultural Imperialism

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Cultural experience of the dominant group is considered norm and all other groups are judged by this standard

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Ethnicity

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A socially constructed classification of groups determined by cultural elements and subjective dimension.

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Ethnic Group

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Composed of people who share a sense of attachment on the basis of cultural criteria and shared history.

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Ethnic Pride

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provides a sense of attachment to an ethnic group

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African American Racial Identity Model

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Cross and Helms. The path that people who are African American take to develop a racial identity.

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5 stages of racial identity

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1. Pre-Encounter-idealizes worldview of white culture.2.Encounter-realizes that race determines life options.3.Immersion-explores self/Emersionjoins community.5. Internalization/commit- continues to nurture positive AA identity and involvement.

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4 Categories of Disability

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Sensory-deafness, hearing impairment, etc. Physical- spinal cord injury, diabetes, MS. Mental - developmental, mental illness. Intellectual/Learning-speech impairments, ADHD.

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Traits of Black Ethnic Group

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Religion plays a major role in many aspects. Require empowerment. Great respect for the elderly. Deep sense of kinship. Making eye contact and building rapport is critical to establishing trust.

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Traits of Native American Ethnic Groups

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The tribe is the supreme entity. Responsible for raising children and making all major decisions. Tribes operate under their own rules and laws. Substance abuse is large problem. Making eye contact and rapport essential to trust. Tribal customs and rituals must be respected.

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Asian Ethnic Group

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Often perceived as successful or model minority. Family is viewed as basic unit. Family needs, prestige, and welfare are most important. Father or oldest male is most respected. Family honor is of great importance. Reluctant to share personal matters with strangers.

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Traits of Hispanic Ethnic Groups

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Family is of great importance. Will rely on family first for support. Largely patriarchal. Social and personal relations are highly regarded. Men are characterized as machismo. Religion and spiritualism are important. Use of the native lang. and non verbal communication.

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When working with a diverse population a social worker should empower a client to:

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Feel pride in their culture and its positive aspects. Have or regain faith in civil, legal, etc. system, while also working to make systems responsive. Retain hope and morals in the face of bad experiences. Learn skills i.e. communication, life, problem solve. Meet comm. needs.

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Ethno-racial assessement

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Involves clarification of cts interpretation of the significance of events and their meaning. It is key to understand the multi-cult. context and environ of person and family. Group ID and membership, broad value perspective, and source of strength and stress

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Critical Reflective Process

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Able to acknowledge and understand the historical and structural dimensions of oppression. What are my beliefs and how do they effect my interactions with others.

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Strengths Based Model

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Provides opportunity to view individ, situations, and environ. from a perspective of possibility of resilience. ID resilience strategies for coping skill and growth. Focused on exploring opport. capabilities, and fostering discovery. Help ct. explore and reinforce strengths.

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Narrative or Telling Mode/Story

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Interact/allow ct. to share story. Ct and SW will explore the ct stories. SW assumes interpretive role by listening, ID'ing themes and reflecting on ct. reaction. Can work together to change story so it becomes pride. Can create positive associations to painful memories.

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Ethnographic Interview

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Interactive process of learning about the individual within their context. Begins with a global exploration of culture and history, and then focus on the individual.

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Culture Bound Syndromes

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Recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked DSM category. Look like characteristic of mental disorder but it's not because it relates to persons culture. Always rule them out first.

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Medical Model of Addiction

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Recognizes addiction as biopsychosocial disease (a.k.a. disease model). Need for life long abstinence and use of ongoing recovery program.

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Social Model of Addiction

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Need for long term abstinence and need for self help recovery groups.

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Behavioral Model of Addiction

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Focuses on diagnosis and treatment of other problems that interfere with recovery.

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Substance Dependence Criteria

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3 or more of following symptoms: 1. Tolerance, 2. Withdrawal, 3. Substance use in larger amounts or over longer period of time. Persistent desire or efforts to cut down. Strong effort to acquire substance. Missing activities becomes of use. Continued use despite problems.

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Substance Abuse Criteria

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1 or more of the following symptom w/in 12 month period. Failure to fulfill major role obligations. Recurrent substance related legal problems. Continued use despite social problems. Not been diagnosed with substance dependence for that substance.

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The chief enabler

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Closest to and most depended on by substance abuser

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The Family Hero

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Usually oldest child. Knows what is going on. Feel responsible. Work hard to make things better. Loneliness, guilt, fear, anger.

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The Scapegoat

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Though of as "the problem." Deprived of positive attention so gets it in negative ways. Act in a manner that justifies accusations.

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The Lost Child

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Withdrawn and loner, does not demand attention. Fantasizes a lot. Low self esteem.

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The Mascot

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Will do anything to make other members feel better. Trouble recognizing and meeting their own needs.

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Addiction Treatment Goals

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Long Term. Establish and maintain functionality in one's life. Total abstinence from all substances. Development of personal insight and healthier coping mechanisms to manage stress. Intermediate-reduce amount and frequency of use. Minimize harmful effects.

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Substance Addiction Assessment

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Full clinical eval. Which should include: type of substance use and degree of intox, severity of w/d symptoms. Quantity, freq. and duration. Medical and Mental conditions. Prior tx history. Family hx of substance use. Social hx. Impact of substance use.

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Types of Substance Abuse Treatment

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1. Detox. 2. Pharmacological. 3. Psychosocial: CBT, Behavioral, AA, Family therapy. 4. Co-Occuring disorders - dual diagnosis can use tx listed above to help both problems. Try to to treat substance abuse first.

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Scope of Substance Abuse Treatment

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Most people require long term tx. Goals include clinical mgmt. strategy to achieve abstinence, preventing relapse, exploring other interventions. Some may need medical attention. Some need residential tx which has better outcomes.

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Alcohol

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Used recreational. Low chance of addiction but does increase with prolonged use. Intoxication and relax. as effect. Confusion, slurred speech, depression, loss of control.

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Narcotics

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Cocaine, codeine, methadone. prescribed for pain, high chance of addiction, initial high followed by relax. Track marks. Extreme weight loss.

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Simulants

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Amphetamine. Prescribed for fatigue and weight loss. High chance of addiction. Rapid heartbeat, more energy. Hyperactivity, lack of sleep and nervousness.

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Hallucinogens

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LSD. Recreational. Addiction is unclear. have hallucinations, dizziness, indicated by trembling, sensitive to light and smells.

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Depressants

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Benzo's. For anxiety and stress, moderate to high addiction. Makes person calm.

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Cannabis

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Mostly for recreation. Addiction is unclear. Have euphoria, change in appetite, disoriented, will have blood shot eyes and loud spech.

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Behavioral Addictions

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Other types of addictions. Not usually classified as addictions but may be mentioned elsewhere in DSM. Usually involve malfunctions in many of the same brain circuits - arousal and reward seeking behavior, deferral of gratification and repetition of actions that result in harm.

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Gambling Addiction

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Seemingly addictive where withdrawal and urge are present. Categorized as compulsion with term "pathological gambling". Disease model not considered relevan.

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Food Addiction

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Classified as "binge eating disorder" also "eating disorder not otherwise specified; recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behavior like bulimia nervosa. Could be neurological.

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Shopping Addiction

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Compulsive buying that leads to senseless contraction of debts with continuous delay of payment. A.K.A Compulsive Buying Disorder which was listed in DSM-III

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Sex Addiction

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Sexual dsyfunction characterized by disturbance in sexual desire and in the changes that occur in the sexual response cycle. There are many sexual disorders which are charact. by unusual sexual urges or behaviors. Can also use substance dependence criteria.

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Internet Addictions

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Usually person with this addiction have other co-occuring disorders. Compulsive-Impulsive Spectrum. Criteria: Excessive use, loss of time, withdrawal including feelings of anger, tension, depression when can't access. Tolerance (need for better computer equip.) negative social problems.

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Love Addiction

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Can be sexual dependency. Addictive cycle of obsession or preoccupation. Maladaptive belief system.

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Love Addiction category

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repeatedly involved in intense co-dependent relationships

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Romance Addictions

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Obsessed with the intrigue and pursuit of romance, and thrill of chase cannot sustain relationship

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Sexual Anorexia

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obsessed with avoiding sex in all aspects - mentally, emotionally, etc

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Sex addtion

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obsessed with sexually related, compulsive, maladaptive behavior.

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Assessment

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Thought of as 1st stage of TX. Establish rapport and gain trust. Start where ct. is exploring presenting issue. If ct can have service they should enter into contract and define goals and roles. Make referrals if need be. Explain confidentiality.

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Contracting

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Written agreement by the parties that defines goals, issues, course of tx, roles and obligations. Contract should be explicit yet flixible. As tx progresses should revisit contract to amend thing.

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Decision Tree of Evaluation and Intervention

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A guide for conducting clinical SW evaluation and intervention. Can be found on pg. 118

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Assessments

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Assess. will vary and is specialized. SW practice will vary in conjuction with the ct. needs, specific issues addressed, time allotted for tx, tx or therapy approach, any requirements by 3rd party reimbursement, and the sw's scope of expertise.

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5 Stage Structure for the Interview

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Rapport and structuring. Let's ct. Know what is going to happen. Gathering info, defining problems, and ID'ing assets. Determining Outcomes. Exploring Alternatives and Confronting Ct. Incongruities. Generalization and Transfer of Learning -helping apply what they learn to daily life.

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Assessment Phase of Treatment

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Begins during 1st session and continues through course of tx. ID as much info that contributes to problems. Should seek info on: personal, familial, social, community, religion, emotional, intellectual, work, economic, and legal.

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Assessment Methods

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Best are multidimensional. Use as many assess. as needed. Things like direct question, indirect questioning (sentence completion) observation of ct in environment. Ct. self monitoring and observation. Obtaining reports.

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Interviewing Methods

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Open and close ended quest., encouragers (gestures), empathy, positive regard, paraphrase, reflection-clarifies and helps ct. further reflect and express feelings. Summary.

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Social Assessment Report

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a.k.a. Social History. focus on hx of social and relational aspects of the ct's functioning. Important to look at how ct. responded to situation in the past to see how they will react. 2 types of data: basic facts and social data, and SW assess. of same data. Should be clear, concise and thorough.

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Genograms and Ecomaps

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Used to graphically depict complex and difficult relationships.

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Genogram

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Similar to family tree. Describes family relationships for one or more generations.

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Ecomap

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Seeks to place the client in the context of their family and social environment.

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Questionnaires and Checklists

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Used to help ct. express exactly how they feel. Developed using common concern or symptoms. Should contain open and close ended questions. Life hx question. is common.

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Mental Status Exam

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Set of question containing item that elicits info regarding clients orientation to time, place, memory, and effect. Determines serious mental illness or need for psychiatric referral.

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Defining the Problem

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Obtaining a concrete definition and description from the ct. in terms of who, what, where, when, how , and how after.

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Question to consider when defining the problem

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How does the client define the problem? How is problem manifested? Who is involved when the problem occurs, worsens, or does not occur? Where does the problem usually occur? In what situations does it occur? How and how often does the problem manifest itself?

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Problem Solving Model

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3 Phases: Contact, Contract, and Action. Developed by Compton and Galoway.

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Contact Phase

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Problem ID: problem as seen by ct and others is defined. Goal ID-state goals, explore resources. Contract-clarify agency resources and commit to further study of problem. Exploration-SW works w/ ct. to explore motivation, opportunities, and capacities.

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Contract Phase

Back 227

Assess. and Eval. -Assess prob and relate it to ct. needs. Formulation of Plan of Action: SW works with ct. to set reachable goals, determine their outcomes, determines appropriate methods of service, and clarifies roles of SW and Ct.

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Action Phase

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Carrying out the plan. Termination. Evaluation.

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Strengths Assessment

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a.k.a. Solution focused assess. Focuses on ct. interests, talents, competencies, and moves in a general direction that avoids problem talk. Goal is to listen to stories instead of rushing assess. The stories will contain evidence of strengths, hope, and vision.

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Questions included in strengths assessment

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Survival? Support? Exception (when were times easier)? Possibility(how will you achieve hopes)? Esteem(what have you heard from others about your character)?Ct Perspective? Change? Meaning-what ct. truly believes and values.

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Assessment of Ct. Motivation

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Two approaches to assessing motivation: decisional balance and readiness to change

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Decisional Balance

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Approach considers the extent to which the costs of a behavior begin to be outweighed by the benefits to be obtained by amending it.

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Readines to change

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the interviewer determines ct. readiness by directly asking the client.

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Motivational Interviewing

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Involves creating dissonance for cts in regard to their actions and how these actions align with personal values or goals they may uphold. Acknowledge the behavior that is contradicting their values, beliefs, and/or goals.

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Stages of Change

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Allow clinician to understand which stage of change the ct. is in when they begin tx. Pre-contemplations, Contemplation, Planning, Action, Maintenance.

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Techniques for Evoking Motivation for Change

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Open ended questions, affirming, reflective listening, summarizing, evocative questions, importance rule(how important is change), pros and cons, elaboration, imagining extremes, looking forward and backwards, and exploring goals.

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Warning signs (Indicators) of Suicide

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Depression, sudden increase in substance use, preoccupation with death, impulsive and reckless behavior, recent or impending loss of someone special, loss of support system, isolation, ineffective coping, expression of loss of control over life, prior attempts or family hx, unexplained change in behavior

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What to do if Ct. shows signs or is suicidal

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Do everything possible to assess and prevent suicide. Ask ct. directly if they have thoughts. ***** to determine risk including family hx. If attempted refer for medical eval immediately. Enter suicide contract.

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Suicide contract

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Client agrees to take certain actions if suicide is being contemplated, such as calling hotline, calling SW'er, etc. If client presents with more serious plan they should be hospitalized.

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Physical signs of child abuse (1)

Back 240

bite marks, choke, pinch, grab, fingernail scratches. Fractures: multiple: 2 or more lines of fractures on one bone. Spiral: Torsion bone broke by twisting. Greenstick: one side of bone is broken other side is bent. Subperiosteal-bone broken but no change in its contour

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Physical signs of child abuse (2)

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Dislocations. Head and internal injuries: Skull fractures. Depressed: severe blow and cause the bone fragments to press against skull cavity. Hematomas-caused by a jolt and is collection of blood that form around surface of the brain. Burns: can be difficult to evaluate.

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Physical signs of child abuse (3)

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Bruises: check under clothes, black of legs, upper arms, chest, neck, head and genitals. Bruises turn from red to blue after 6-12 hours. Turns blackish purple after another 12-24 hours. Dark greenish tint w/in 4-6 days. Pale green or yellow w/in 5-10 days.

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Behavioral Indicators of Physical Abuse

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delayed motor and social development. Passivity, litter interest in toys or play. Enuresis(inability to control bladder) encopresis(can't control feces), low self esteem, w/d, running away, cutting, hyper vigilance, scared of failure, regression, poor peer relations, substance use

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Emotional or Psychological Child Abuse signs

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Depression, child is w/d, behavioral problems, acting out, repetitive, rhythmic movement, preoccupation with detail, unreasonable demands placed on child, child is triangulated into marital conflict.

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Child Neglect

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Act of omission rather than assault. 3 forms-physical, educational, and emotional. Failure to thrive, underweight, hair loss, begging for food, school absence, physical and medical problems untreated, excessive fatigue, poor hygiene, not being supervised, inadequate sleeping arrangement.

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Assessing for Child Sexual Abuse (1)

Back 246

bruising/scars around vagina or penis, blood in underwear, bruises or abrasion on thighs and legs, recurrent UTI's, Enuresis or fecal soiling, depression or suicidal thoughts, fears and phobias, sudden possession of money, toys or other gifts.

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Assessing for Child Sexual Abuse (2)

Back 247

Age inappropriate behavior, advanced maturity or regression. Eating disturbance, behavioral issues, self destructive behavior, inappropriate sexual behavior, promiscuity, dissociation.

Front 248

Assessment of Crisis and Trauma

Back 248

Be brief, immediate and focused. Goal is to determine urgency and severity of situation and resources. Look at risk factors.

Front 249

4 categories of resources for crisis and trauma

Back 249

Internal-how has ct dealt with previous issues. External-support system and access to it. Community-outside resources including professionals. Spiritual.

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Risk factors to be looked at during crisis

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Age, development phase, health, disability, pre-existing conditions, previous traumatic events, strength of support system, coping skills, expectations of self and others, status and cultural barriers.

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Assessment of a rape crisis

Back 251

Give victim back power. Explain your role. Do not interrogate. Do not give food or water. Assess for suicide and assure ct that is normal. Listen and make sure ct knows you are listening. Don't make promises can't keep. Keep ct. comfy. Check your emotions

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Role of a Rape Crisis Responder

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Provide crisis intervention, provide support, and provide info and options.

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Crisis Theory Stages of Crisis

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a. shock and disorientation, b. expression of feeling, c. denial or minimizing loss, d. sadness, low self esteem, self blame, and loss of control, e. letting go, f. acceptance, g. reflecting.

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Types of coping skills for sexual assault/victims/survivors

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a. perceptual, b. cognitive change, c. support networking, d. stress mgmt. and wellness, e. problem solving, f. description and expression of feelings.

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Phase 1 of Crisis Period

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Initial tension is experienced and previous coping mechanisms begin to operate.

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Phase 2 of Crisis Period

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Tension increases and coping skills do not produce success at reducing the dress.

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Phase 3

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Tension continues to increase and external and/or internal emergency methods come into play.

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Phase 4

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Acute phase follows if emergency mechanisms did not work and behavior dysfunctions develop and/or emotional control is lost.

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Step 1 of Crisis Intervention

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Determine the level of disruption, coping skills, and personal strengths.

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Step 2 of Crisis Intervention

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Decide what type of assistance is most beneficial.

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Step 3 of Crisis Intervention

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Act by encouraging the person to vent feelings, by providing info, interviewing with others present, or by simply being there.

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Step 4 of Crisis Intervention

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Empower the client to function in pre-crisis manner by returning power/control to individual.

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Options available to rape victims

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evidence collection, reporting to law enforcement, std testing, taking prophylactic medication, pregnancy testing (done before ER. contraception is taken)

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Role of law enforcement

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protect victim, attempt to apprehend suspect, protect crime scene

Front 265

Intelligence Quotient Tests

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Used to determine whether the ct. can fully understand and appreciate the presenting problem, assessment, diagnosis, and tx plan. Most commonly used are: Weschler Adult Intelligence Scale (WAIS) and WISC - Children

Front 266

DSM Information

Back 266

Tool that describes and categorizes the symptoms, manifestations, and criteria associated with various mental disorders. Separated into "Axes" which cluster mental disorders based on their chief ID'ing characteristic. Does NOT discuss cause.

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DSM Info Continued

Back 267

Compatible but not identical to ICD. All disorders have codes. Also can use severity (mild, moderate, severe) and course specifiers (partial/full remission, prior hx) can give provisional diagnosis. should describe behaviors that support diagnosis.

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DSM Axis I

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Clincial Disorders (schizophrenia, depression)

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DSM Axis II

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Mental retardation and personality disorders

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DSM Axis III

Back 270

Physical Disorders

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DSM Axis IV

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Psychosical factors that affect diagnosis and tx.

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Axis V

Back 272

Global Assessment of Functioning. Can assess current level of function, or highest level of function over last year.

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Treatment Planning

Back 273

Consists of goals and objectives. Should contain specific details answering "who, what, where, when, how and why". What the ct will be doing, when they will be doing it. Helps clarify.

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Goals

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Broad high level statements of what is hoped to be achieved through treatment

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Objectives

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more specific and concrete steps to achieve the goal. There can be many objectives for one goal.

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Important aspects of Tx. Planning

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Ensure that the goals and objectives are based upon needs of ct. Do not impose your own perspective. Ct. has final say. Should clarify role and social work role depending on type of relationships. Establish boundaries.

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Treatment Considerations for Level 1

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Adaptive functioning with min. to no symptoms. Tx. goal is to increase knowledge, understanding, problem solving. Focus on self-efficacy and education, prevention. Use didactic/educational, community based, therapeutic classes, recommended reading.

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Treatment Considerations Level 2

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Mild to moderate symptom. Goals: cognitive restruct. behavior modification. Focus on decrease of sympt., self care, improve coping, mgmt of stress. Use individ. therapy, conjoint therapy, family therapy, etc.

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Tx. Considerations Level 3

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Moderate symp. Higher level of care. Improve daily functioning. Stabilization, daily activity schedule, productive activities, use of social support. Urgent care, IOP, medication, eval and monitoring, therapeutic and educational groups, case mgmt.

Front 280

Treatment Considerations Level 4

Back 280

Severe. Danger to self or other. Provide safe environ. Stabalize all aspects of ct. life and environ. decrease symp. meds, improve judgement, impulse control. IOP, partial hospital. maintain in safe setting with social support.

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Tx Considerations Level 5

Back 281

Acute. Provide safe environ. and rapid stablization. Stabilization, meds and monitoring. IOP, and hospitalization, group, case mgmt.

Front 282

TX Considerations Level 6

Back 282

Acute and can't stabilize. Provide safe environ. and protect ct's and others. Use Meds. Hospital and IOP.

Front 283

Evaluation and Termination

Back 283

Time changed is measured and intervention is evaluated. Should begin once goals have been met. Summarize goals and what needs to be done in future to maintain goals. Evaluate SW method of tx.

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Process of Termination

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Should be mutually agreed on. Ct. chooses termination. If SW chooses explain reason and make a plan and refer. Allow feelings to be expressed. Let. ct know they can come back. Emphasize learning and problem solving. Evaluate results of tx then follow-up

Front 285

Mental Retardation

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Intellectual functioning and impairment in adaptive functioning with onset b4 age 18. B/wn 71-84 Borderline intellectual func. 50-55 to 70- Mild. 35-40 to 50-55 Moderate. 20-25 to 35-40 Severe. Below 20-25 Profound

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Autistic Disorder

Back 286

Impairment in social interaction and communication. Restrictive repetitive behaviors often present, including rocking back and forth, head banging, Onset prior to age of 3.

Front 287

Attention Deficit Hyperactivity Disorder

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Persist. pattern of inattention and or hyperact. Symp. must be present in 2 or more situations (home, work, school). Can be diagnosed in adult but must be present prior to age 7. Ritalin, Adderall, Vyvanse, and Cyclert.

Front 288

Conduct Disorder

Back 288

Patterns of behavior that violate human rights includ. aggression to people and animals. Destruction of property, theft, running away. If over 18 would be called antisocial personality disorder. Child with CD or may not have AsPD.

Front 289

Oppositional Defiant Disorder

Back 289

Hostile and defiant behavior (e.g. losing temper, arguing with adults, ignoring requests, resentful, spiteful, etc.)

Front 290

PICA

Back 290

Eating one or more non-nutritive substances, paint, hair, intects, on a regular basis.

Front 291

Tourette's Disorder

Back 291

Motor and vocal tics many times a day for more than 1 year. Onset b4 age 18.

Front 292

Separation Disorder

Back 292

Excessive anxiety concerning separation from home or from those to whom the individual is attached. Onset b4 age of 18.

Front 293

Delirium

Back 293

Inability to focus or remember, disorientation and language disturbance. The disturbance is brief and fluctuates through the course of day.

Front 294

Dementia

Back 294

Multiple cognitive deficits and intellectual deterioration. Involves problems with memory, language, perception, irritability, agitation, delusions and loss of control. Symptoms are stable.

Front 295

Schizoprenia

Back 295

Psychotic Disorder. Includes delusions, hallucinations, disorganized speech, and catatonic behavior. 5 types: paranoid, disorganized, catatonic, undifferentiated, and residual. At least 6 months. Schizophreniform is less than 6 months.

Front 296

Schizoaffective

Back 296

Psychotic Disorder. mix of symptoms suggestive of mood disorder and schizophrenia.

Front 297

Brief Psychotic Disorder

Back 297

sudden onset of delusions, hallucinations, disorganized speech, or catatonic behavior that lasts for at least 1 day, but less than 1 month.

Front 298

Prescribed meds for psychotic disorders

Back 298

Thorazine, Melloril, Stelazine, Prolixin, Haldol, Loxitane, Clorazil, Risperal, Zyprexa

Front 299

Major Depressive Episode

Back 299

Mood Disorder. Depressed mood, loss of interest in all activities, weight loss, insomnia, fatigue, feelings of worthlessness, inability to concentrate, thoughts of death for at least 2 weeks.

Front 300

Manic Episode

Back 300

Mood Disorder. Abnormally elated, expansive or irritable mood for a period of at least 1 week. Feel inflated self esteem, decreased need for sleep, talkative, increase in goal orientated behavior, excessive involvement in pleasurable activities.

Front 301

Mixed Episode

Back 301

Mood disorder. Criteria for both depressive and manic episode are present nearly everyday for at least 1 week.

Front 302

Hypomanic.

Back 302

Mood disorder. Abnormally elevated, expansive, or irritable mood that lasts at least 4 days. Involves the same as a a manic episode, but is a shorter period of time.

Front 303

Bipolar 1

Back 303

One or more manic episodes or mixed episodes.

Front 304

Bipolar 2

Back 304

One or more major depressive episodes, combined with at least hypo manic episode.

Front 305

Cyclothymic

Back 305

Part of bipolar disorder. hypomanic symptoms and depressive symptoms that do not meet criteria for a major depressive episode for a period of at least 2 years.

Front 306

Commonly prescribed meds for bipolar disorder

Back 306

Lithium, depakote, and clonazepam.

Front 307

Major Depressive Disorder

Back 307

one or more major depressive episodes without history of manic, mixed, or hypomanic.

Front 308

Dysthymic Disorder

Back 308

Depressed mood that occurs for most of the day and for more days than not. Also involves poor appetite, insomnia, or hyperinsomnia, low energy, low self esteem, poor concentration and feelings of hopelessness for at least 2 years.

Front 309

Commonly prescribed medication for depressive disorders

Back 309

Prozac, paxil, zoloft, celexa, tofranil, elavil, marplan, nordil, and eldeplye.

Front 310

Panic Attack

Back 310

Intense fear or discomfort, including palpitations, pounding/accelerated heart, sweating, trembling, shortness of breath, feeling of choking, fear of dying, chills, hot flashes, tingling sensation.

Front 311

Agoraphobia

Back 311

Anxiety about being in places or situations from which escape might be difficult or embarrassing, such places are avoided

Front 312

Panic disorder without agoraphobia

Back 312

recurrent, unexpected panic attacks, followed by persistent concern about having additional attacks.

Front 313

Specific Phobia

Back 313

Excessive or unreasonable fear triggered by the thought or presence of an object or situation.

Front 314

Social Phobia

Back 314

excessive fear triggered by social situation

Front 315

Obsessive Compulsive Disorder

Back 315

Obsessions on compulsions that take up a considerable amount of time in one's day and causes impairment in that persons social, academic, or occupational functioning.

Front 316

Post Traumatic Stress Disorder

Back 316

symptoms following exposure to traumatic event involved threatened death or serious injury. Difficulty sleeping, anger, difficulty concentrating, hyper vigilance, exaggerated startle response.

Front 317

General Anxiety Disorder

Back 317

Excessive anxiety and worry occuring more days than not for a period of 6 months about certain events or activities. Being restless, fatigue, difficulty concentrating, irritability, muscle disturbance

Front 318

Meds for Anxiety and Panic Disorders

Back 318

Librium, Xanax, Haldol, Celexa, Paxil, Klonopin, Valium

Front 319

Somatization Disorder

Back 319

Somataform Disorder. Multiple physical complaints b4 the age of 30 that occur for a period of several years and results in tx. being sought for significant impairment in social or occupational functioning.

Front 320

Factitious Disorder

Back 320

Somataform Disorder. Intentional production or feigning of physical or psychological symptoms motivated by the desire to assume the sick role. Malingering is similar but not a diagnosis.

Front 321

Dissociative Identity Disorder

Back 321

2 or more distinct identities or personality states that recurrently take control of the individuals behavior accompanied by the inability to recall important personal info. Used to be known as multiple personality disorder.

Front 322

Anorexia Nervosa

Back 322

Refusal to maintain a minimally normal body weight, the intense fear of gaining weight, a disturbance in body image, and no period.

Front 323

Bulimia Nervosa

Back 323

Binge eating and inappropriate compensatory behavior to prevent weight gain, vomiting, laxative use.

Front 324

Paranoid Personality Disorder

Back 324

Person. Disor. Cluster A. Pervasive distrust and suspicion of others.

Front 325

Schizoid Detachment

Back 325

Person. Disord. Cluster A. Detachment from social relationships and a restricted range of expression of emotions.

Front 326

Schizotypal

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Person. Disord. Cluster A. Social and interpersonal deficits marked by discomfort with close relationships.

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Antisocial Personality Disorder

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Cluster B. Blatant disregard for rights of others. Must be 18 with evidence of conduct disorder before age 15.

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Borderline Personality Disorder

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Cluster B. Instability of interpersonal relations, self image, and affects, and marked impulsivity.

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Histronic Personality Disorder

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Cluster B. Excessive emotionality and attention seeking behavior.

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Narcissistic Personality Disorder

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Cluster B. Grandiose sense of self, need for admiration and lack of empathy.

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Obsessive Compulsive Personality Disorder

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Cluster C. Preoccupation with order, perfectionism, and control at expense of openess and efficiency.

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Avoidant Personality Disorder

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Cluster C. Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

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Dependent Personality Disorder

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Cluster C. Excessive need to be take care of that leads to submissive and clinging behavior.

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Roles of a social worker

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broker, advocate, educator and teacher, counselor, case manager, staff development coordinator, administrator, lobbyist or politician.

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Active or Reflective Listening

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Only speak to get better understanding, further response, rephrasing, paraphrasing, clarification, encouragement, summarization, exploring silence, partialization (breaking up overwhelming thoughts), reflection of feeling, non verbal communication. Use variety, avoid asking questions.

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Direct practice

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SW'ers working with individuals, couples, families, and groups. Can use various practice frameowrks. Common goal is to assist ct's in coping more effective with problems of living and improving quality of life.

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Indirect practice

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does not involve immediate or personal contact with the clients; administration, research, and policy.

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Choosing Frameworks

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Should be chosed based upon a. clients presenting issue, b. psychological, theoretical base, c. type of treatment, d. goals of treatment, e. time and resource available to reach goals.

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Generalist Framework

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Most flexible, can be open and use a variety of theories, models, and methods of treatment. Specialization perspective is opposite.

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Systems framework

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SW focuses on the interplay between biological and social systems as they related to human behavior. SW should explore the ct's interaction with their social environment when identifying and assessing the issue or problems.

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Ecosystems Framework

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views individual in context of their environment. Identify and view the clients behaviors as adaptations to the environment.

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Ethnic sensitive framework

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be attentive and sensitive to a client's culture, ethnicity, and religion. Must view a clients issue or problem in view of any differences in cultural values or traditions to fully understand ct. experience.

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Feminist Framework

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Most relevant when client is female or client's issue is based on the effects of gender or sex role discrimination. Must validate the feminine dimension of the client and issue. Consider the impact that gender may have on the ct's perception of issue.

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Strengths Framework

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Explore, focus on, mobilize, and embellish the clients strength. Do not focus on the problem, focus on the potential of achieving goals.

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Theoretical base of psychoanalytical approach

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Psychoanalytic theory, ego psychology, psychosocial theory, object relations theory.

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Key Principles of psychoanalytical approach

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person should be viewed in context of social environ. behavior is result of unconscious motives and drives, dysfunction and disorders are rooted in conflict and anxiety provoking experiences, tx involves bringing repressed info into consciousness, help person understanding origin of symptoms.

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Role of SW in Psychoanalytical Approach

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relationship used to resolve conflict.

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Transference

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Clients unconscious, emotional, reaction, feelings, desires and defenses with respect to SWer

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Countertransference

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SW'ers unconscious, emotional reaction, feelings desires, and defenses with respect to Ct.

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Assessment in Psychoanalytical Approach

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begins during first session and continues, should look at etiology, and seek to understand how and why of conflict. Info and facts are gathered by initial interview, observing client and non verbal behavior.

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Phases of Tx. in Psychoanalytical Approach

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engagement-establish relationship, contracting-developing mutual understanding with ct. regarding tx plan, goals, etc., ongoing treatment works on resolving issues with focus on current function.

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Treatment Concepts and Techniques of Psychoanalytical Approach

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free association, resistance(confront ct.), confrontation, direct influence, sustainment, ventilation, delve into past, and dream analysis.

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Theoretical Base in Behavior Approach

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behavioral theory, respondent, classical conditioning, operant condition, and social learning

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Key principles in Behavior Approach

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people have behaviors that are dysfun. not mental issues, only thing to explore is current behavior, a person consciously chooses to change, change can occur through conditioning, behavior change must be specified and defined, most effect when change is voluntary

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Role of SW'er in behavioral approach

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relationships is not as significant. SW should always be empathetic, facilitate, and supportive.

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Assessment in Behavioral Approach

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Identifying problem behaviors that ct. wants to change

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Phases of Tx in Behavioral Approach

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help ct. prioritize the behaviors that ct. seeks to change. Those behavior and even surrounded the behavior (ABC) should be examined. Work with ct to set goals and target for change.

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Tx Concepts and Techniques in Behavioral Approach

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Contracting, ID target behavior, establish new A and C, specify what will happen if contract violated, specify positive reinforce rs, specify negative reinforcers, specify how behaviors will be kept track of.

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Key Principles of Cognitive Approach

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emotions and behaviors are direct result of thought and cognition. key to changing behavior is IDing and challenging false beliefs. problem focused and goal oriented, focus on present, teach ct. how to change thoughts.

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Role of SW'er in Cognitive Approach

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Assist ct. in IDing and changing thoughts and beliefs. Must collaborate and participate.

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Assessment in Cognitive Approach

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ID client misconceptions and false beliefs

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Phases of Tx in Cognitive Approach

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work with client to establish goals for tx. Then enter into contract regarding scope and goal of tx.

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Tx. techniques in cognitive approach

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clarification, explanation(teach ct. how to ID beliefs and triggers) interpretation(help ct. with insight), writing assignments, paradoxical direction (ct. is directed to engage in behavior) and reflection.

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Key principles of Gestalt Approach

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All people can change and grow. Being aware of your feelings about change will help. Focus on client. Promotes awareness in the person of their inner/outerself. Help ct. become aware of behaviors, recognize and expand on other behavior take responsib.

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Role of SW'er in Gestalt Approach

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Assume that Ct. has all the tools needed so SW'er should act as facilitator to enable client to become aware of themselves and take responsibility for action. Be open and honest with ct. Warm and supportive

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Assessment in Gestalt Approach

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Very different, Sw'er not concerned with most of things in typical assessment. No DSM diagnosis.

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Phases of Tx in Gestalt Approach

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Similar to other type of tx. Identify and discuss ct. presenting issue and goals. Enter into contract.

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Tx concepts in Gestalt Approach

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Confluence-person focuses on false similarities and ignores differences. Introjection-person inappropriately receives and internalizes messages from others. Projection. Retroflection-person does to herself what she would like to do to otherpeople Dialogue-use empty c

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More tx concepts in Gestalt Approach

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Enactment of Dreams. Rehearsal-practice thought, feeling or behavior. Exposing the obvious - bring ct. thoughts to awareness. Exaggeration-helps ct. become aware of issue by exaggerating physical or verbal action.

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Key principles of task centered approach

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change only behaviors ct. finds problem with. behaviors are conscious actions by individuals. people are in control of actions. ct. must want change. Sw can suggest change, help problem solve. Short term 6-12 sessions over several months.

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Role of Social Worker in task centered approach

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act as though hired to assist client with the desire to change. Engage and collaborate. No hidden goals or agenda.

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Assessment in Task Centered Approach

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ID the problem, behavior, and exploring associated behaviors, issues, barriers and goals.

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Phases of Tx in task centered approach

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ID and work together to define steps required to solve problem and change behavior. Make contract to detail behavior to be changed, skills and actions, required to achieve change, length of time, cost. Each sesion should outline, review and practice skills for change.

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Crisis

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Acute, stressful, highly emotional, disastrous event that person is unable to access coping mechanisms.

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Crisis theory

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when experiencing a crisis the person acts unpredictably .

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Crisis Sequence

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1. stressor or bad event, 2. bad anxiety, especially after exhausting coping skills, 3. last straw which makes person seek help, 4. state of emotional turmoil, 5. gain new coping skills.

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Key principles of Crisis Intervention

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Want ct. to develop new coping skills. Want to focus on immediate crisis, deal with past issues later. Short term intervention but can be referred for long term.

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Role of Social Worker in Crisis Intervention

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have expertise in area of the crisis (rape, suicide). Be authoritative and knowledgable. Try to avoid too much attachment from client.

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Assessment in Crisis Intervention

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Immediacy does not allow for full assessment. Must be focused on current crises. Explore: events of crisis, crisis response, cts cpast response to anxious events and client support.

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Phases of TX with Crisis Intervention

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brief and time limited. ID events that led to crises, thoughts and emotions evoked by crisis, skills needed to manage anxiety, and tasks associated with resolution of crisis. Tend to use problem solving techniques.

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Grief Counseling

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Short term therapy. Grief is a natural and normal response to a significant loss. Person must go through each of the stages of grief and adjust and adapt to loss.

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5 Stages of Grief

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Denial, Anger, Bargaining, Despair (Depression), Acceptance

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Key principles in family therapy

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family provides people with unity, security, etc. Dysfunction in family is bad, Dysf. in one system can cause dys. in another system. Focus on presenting issue not all issues

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Family Subsystems

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Spousal, parent-child and sibling

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Role of Social Workers in Family Therapy

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should be educator, facilitator, and role model. Be neutral. Encourage family to observe each other.

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Assessment in Family Therapy

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occurs through treatment. Focus on dysfunction/function and subsystems.

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Types of Family Therapy

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Family entire family tx to improve interaction. Collaborative-each family member treated by 2 or more SW. Complementary- supplemental therapy (like group)

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Treatment approaches in family therapy

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Communication-all problems caused by comm.Structural-focus on interactions. Strategic family therapy-focus on roles and patterns. Social learning-family prob due to lack of basic skills. Narrative-have family tell their stories, construct alt. scenarios.

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Group therapy

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Can be helpful but not for everything. Feel less judged, and less alone. Should not be used as only form of tx.

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7 major types of groups

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Educational, growth, remedial (psychotherapy), self help, socialization, support, and task groups.

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Group structure

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Closed-sw makes all decisions same set of ct.Open-ct can come and go. Short-limited time, one focus, Natural-forms naturally SW enter later, Formed-created to address certain issue or obtain common goal

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Role of SW'er in Group Therapy

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active, acts as facilitator and educator. Viewed as gatekeeper. Keep group safe. Nurture. Respect group members. May utilize self disclosure. Watch body language

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Group formation

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similar interest, but different life experiences. no more than 12 people no less than 8. The younger the group the less members. Want diversity, but don't just want 1. # of sessions revolve around goals. Session length look at age. Quiet room, make circle.

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Engagement phase of group therapy

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engage members and gain commitment. define function, purpose, goals, structure. Want statement of commit from SW and group. Complete assessment-note group processes and needs.

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Middle Phase of Group Therapy

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overall purpose should be clear, group members should be comfortable, good purposeful interaction

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Ending phase of group therapy

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termination stage, begin dealing with feelings of loss and separation. finalize process and determine future goals.

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Stages of group development

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1Preaffiliation-member become acquainted and decide if participate. 2Power and control-roles made, one person takes control. 3. Intimacy-become closer, 5.Differentiation-members express own opinion.5. Termination-revise goals address issues

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Sociogram

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diagram used to depict relationship between members.

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Approaches to working with community or larger system

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Horizontal-deals with community problems or issues w/in community. Vertical-deals with community problems by reaching outside community.

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Key principles in systems theory

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did person cause change in environ, or vice versa? some parts cannot be separated from whole. watch person as part of total life situation.System is one unit comprised of person and their interaction.

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Open System

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Accepting of input from source outside environment and willing to change.

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Closed System

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rigid boundaries, do not want change, do not want to provide output.

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Boundaries in System Theory

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line between one system and others. Help people see what is in each system, and how they relates.

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Roles in system theroy

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Usual behavior of person in social position. Expected. Enacted-how the person behaves. Role Overload-a set of roles combined that are too much. Role Ambiguity-unclear expectations. Role Conflict-incompatible expectations to various roles.

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Entropy

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describes the dissolution or disorganization of a system. Used to describe closed system. Over time closed system will begin to be alike, so they will lose organization.

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Homestatic

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A concept used to describe the tendency of a system to seek restoration and stability.

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Tension

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levels of conflict that occurs temp on individuals. Considered a good thing as it is necessary for systems to adapt.

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Ecosystems or Life Model Theory

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relation b/wn people and social environ. All people undergo process of adaptation-person and environ change and adapt to one another. Want to improve goodness b/wn client and environment. Change ct. perceptions and thoughts about environ as needed.

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Record Keeping

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describe and ***** client issue, state purpose and type of service, outline plans, activities and goals, eval progress and outcome.

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Narrative record keeping

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all information is put together and an ongoing basis in narrative form.

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Process recording

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verbatium. Begins with facesheet, followed by statement of problems and goals, then entry made after each contact.

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Problem oriented record keeping

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includes face sheet, check list of problems in rank order, plan to solve problems and progress notes.

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SOAP note

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Subjective, objective, assessment, plan

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Person oriented record keeping

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goal orientated adaptation to problem recording. Face sheet, assessment and treatment plan, progress notes, and progress review.

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Outcome Evaluation

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focuses on evaluation of results after entire program is complete.

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Experimental Evaluation

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utilizes experimental and quasi experimental study designs. Independent and dependent variables are defined and tested.

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Performance Audits

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3rd party reviews program. Different parts.

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Decision oriented evaluation

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used to determine which components work, and which to improve.

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Process Oriented Eval

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Formative eval. A program from a point in time under specific conditions. Determine if program is functioning.

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Participatory Eval

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Inductive community approach. action research, done by person directly effected. Evaluate multiple interests at one time(cluster evals). Allow multiple programs to learn from one another. Self Eval-staff eval program.

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Role of the Supervisor

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Recruitment and orientation. management(manages supervisees, oversees caseload, and delegates work so it is manageable. Education, training and staff development. Group supervision, assessment, support, advocate, role model, and program eval.

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Supervision Perspectives

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Personality P. focus on characteri. of person. Situations-focus on issues encountered. Organizations-focus on function of organization. Interactional-focus on interactions

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Mission of Social Workers

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To enhance human well being and help meet basic human needs of all people in society

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Core Values

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Service, Social Justice, Dignity of the Individual, Importance of Human Relationships, Integrity, and Competence.

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Tarasoff v. Regents of university of CA

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Case established legality of SW and other professionals to inform and warn a threatened victim of any harm that ct. may cause.

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When can you inform others of threatened harm

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1.genuine psycho-therapist/patient relations. 2. when ct. has said a serious and imminent threat of violence again the other person. When person is identifiable.

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When can you inform others of HIV status

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Ct. must be infected with HIV without a doubt. The parties have unprotected sex or share needles. Behavior is unsafe. Client intends to continue after being educated on risks. Transmission is likely to occur.

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Federal Privacy Act of 1974

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Cts be informed that records are being kept. Have right to access those records. May have a copy. May only be used for specifc purpose. Only pertains to federal agencies and place receiving federal funds. NASW agrees with this policy.

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Exceptions to Confidentiality

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Emergency situation. Need to know basis with co-worker. Mandated reporting. Subpoena of court order. Tx. Continuity. Insurance coverage. Client request.