Msw Comp Exam Family Assessment & Intervention

Front 1

Investigative stance (as a theoretical assumption of family treatment)

Back 1

Focus is on here-and-now behavior and feelings determined by a selective investigation of history, including both events and relationships often serving a useful purpose in the production of change.

Front 2

Evidence based practice (as a theoretical assumption of family treatment)

Back 2

the use of the best scientific evidence when making a clinical decision – use of techniques that work. Also, evidence based social work not only encompasses the principles of evidence based practice but also calls for evaluation of one’s own practice activities.

Front 3

Social Role (as a theoretical assumption of family treatment)

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role requirements are learned in the process of social interaction, and the occupants of a role see it as carrying a specific status for the occupant and for others with whom the occupant interacts. Learning the behaviors expected in various roles involves both observation and teaching.

Front 4

Family homeostasis (as a theoretical assumption of family treatment)

Back 4

in the case of family, homeostasis implies that the family acts so as to achieve a balance in relationships. All parts of the system function in such a way that change is unnecessary for realization of family goals. This is a self-regulatory mechanism through which a state of equilibrium is maintained. Most families maintain a balance in relationships through wholesome growth-producing transactions. This is not always done in a healthy way or in the best interest to all its members (ie – parents fight, child feels threatened they will separate, child acts out, parents focus attention on child instead of fighting, threat for separation subsides, family remains in tact. This becomes a cycle for the family and a pattern of behavior for the family).

Front 5

Family triangulation (as a theoretical assumption of family treatment)

Back 5

it is accepted that the formation of a unit of three as a way of relating is a process common to all emotional systems. The triangle, involves three persons – a two person system has difficulty maintaining its stability under the pressure of anxiety and tension. When this system experiences intolerable frustration, it triangulates a third person or an issue in the hope of reducing the level of tension. The third person can be a child, friend or social worker for instance. In a triangle situation, the third operative person or issue becomes the object of attention for at least one of the original two.

Front 6

Family rules (as a theoretical assumption of family treatment)

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essentially relationship agreements that influence family behavior – some rules are explicit and established along the lines of specific roles and expectations of family members. Most, though, are implicit – having been established over time by repeated family transaction.

Front 7

Family myth (as a theoretical assumption of family treatment)

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essentially consists of family members’ shared beliefs and expectations of each other and their relationships. It is characterized by unquestioned sharing of beliefs and expectations by all family members, which results in automatic agreement on the myth without further thought by any member. In spite of possible irrationality, family members perceive it as an emotionally indispensable and necessary part of their reality. It not only determines the behavior of all family members but also reveals something about family relationships.

Front 8

Separateness and connectedness (as a theoretical assumption of family treatment)

Back 8

it is important the family members act in concert with others and individually. A process of being together and being apart from one another characterizes human relationships. Two strong emotional forces are at work in this process – the need for emotional closeness, which brings people together; and the desire for individuality and autonomy, which moves the individual away from the control of the group.

Front 9

Feminist Orientation (as a theoretical assumption of family treatment)

Back 9

this perspective in family treatment provides the therapist with a necessary reminder of the impact of gender differences in the helping process. Feminist family therapist view attempts to help men and women fit into traditional role definitions as unhelpful and destructive. This view of treatment is dedicated to overcoming and working with gender discrimination as a political and therapeutic goal.

Front 10

Strengthening Family Structure (as a theoretical assumption of family treatment)

Back 10

family structure: who speaks to whom, who listens to whom, whose ideas are adopted, who gets put down or shut out or ignored, who seldom or never speaks – all aspects of communications that tell of role, status, power, control, affection, and distance regulations in relationships. Include changeability, interpretation versus behavior change, growth versus problem solution and emotionality-rationality-activity

Front 11

Changeability in Strengthening Family Structure:

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one concern about structure is that it should not be so rigid as to prohibit variability and change. At the same time, it should be sufficiently stable so that members can experience the family as dependable and predictable enough to provide some guidelines by which the individual members can be clear about what roles and behaviors are expected.

Front 12

The structural approach

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emphasizes the importance of family structure, family subsystems, and boundaries around the family, its members and its subsystems.

Front 13

Family structure (in the structural approach)

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the invisible set of functional demands that organizes the ways in which family members interact. Repeated transactions establish patterns of how, when, and to whom to relate and these patterns underpin the system.
Another aspect of family structure is rules that govern family organization and transactions within the family. Rules are often recognized in the way various family members protect each other.

Front 14

Family subsystems (in the structural approach)

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family members joining together to carry out different functions create subsystems. Subsystem might be centered around age, gender, or common interest. Common subsystems are adults, siblings, and parent/child.

Front 15

Couple subsystem

Back 15

two adults coming together with the desire to exist as a unit.

Front 16

Parental subsystem

Back 16

arrival of first child. Largely child-focused and has executive responsibilities for the entire family system.

Front 17

Sibling subsystem

Back 17

the subsystem in which children learn how to relate to each other, including how to share, disagree, make friends, bargain and protect themselves without interference from adults.

Front 18

Parent-child subsystem

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parents and children interact as a functional unit within a boundary. Different from parental or sibling because one unit of the subsystem is from a different generation.

Front 19

Boundaries (in the structural approach)

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the invisible barriers which surround individuals and subsystems, regulating the amount of contact with others. The function of boundaries is to safeguard the differentiation and autonomy of the family and its subsystems.

Front 20

Role of the therapist in the structural approach

Back 20

must enter the system that needs to be changed by accommodating to the rules of the system and joining with the family. the therapist brings to the family encounter a series of hypotheses that are tested, expanded, and corrected when necessary.
i. Confirmation
ii. Role reversal
iii. Boundary making
iv. Joining

Front 21

The communications approach

Back 21

it is accepted in this approach to family treatment that all behavior has communication value and conveys several messages on different levels. The family is seen as a living system that maintains a relationship with the environment through communication, which involves the sending and receiving of message and a feedback process. As a results, family relationships are products of communications. Family members establish rules that regulate the ways they relate to each other and to the outside world. Communication is defined as all verbal and nonverbal behavior within a social context.

Front 22

Double binding communication (in the communications approach)

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exchange of communications in these families is characterized by sending of incongruent messages, usually within the boundary of a complementary relationship.

Front 23

Metacommunication (in the communications approach)

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sending of a message about a message, both of which are sent at the same time.

Front 24

Role of therapist in the communications approach

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therapist identifies the symptom to be changed as a communicative message and then focuses attention on each family member and demonstrates a readiness to listen and to touch and be touched. No unusual for the therapist to hold the hand of a family member during therapy.
i. Sculpting
ii. Metaphor
iii. Evidence base

Front 25

The strategic approach

Back 25

a problem focused strategy concerned with repeated sequences of behavior and dysfunctional hierarchies within the family. Therapist is at the center of all activity, with each family seen as unique. Therapy is typically accomplished by the therapist assessing and understanding the family’s life cycle stage of development, the hierarchical dysfunction, and the repetitive sequence or cycle of family interactions, then correcting the hierarchy and breaking the cycle through straightforward or paradoxical directives. Many similarities to structural and communications approaches (i.e: all three give attention to: family homeostasis, communications, boundaries and triangles).

Front 26

Role of therapist in the strategic approach

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she must be in control of what happens in a therapy session. Includes being directive and persuasive, yet remaining sensitive to client concerns. Presenting problem is important to the strategic therapist and should be given a great deal of consideration.
i. Directives and homework tasks
ii. Relabeling
iii. Empowerment
iv. Straightforward directives
v. Paradoxical directives

Front 27

The social learning approach

Back 27

recognizes the importance of family functioning and accepts the mutual impact of interactions of family members, which is shared by a number of other approaches to family therapy. Horne defines social learning as an education in human relations that takes place within the social environment. Social learning therapy has evolved as a general set of principles that can be readily applied to a wide variety of human problems. Also referred to as functional family therapy and systemic behavioral family therapy Ways behavior is learned: Positive reinforcement, Negative reinforcement, Accidental learning, Reciprocity and Coercion

Front 28

Role of therapist in the social learning approach

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define family’s problem in a way that is understandable and amenable to change. Requires a thorough assessment of the difficulties experienced by family members. Observational data can be used to help in this process. Social learning approach emphasizes: analyzing problems, formulating strategies for intervention and evaluating the change that takes place during the therapy process.
i. Behavioral rehearsal
ii. Contingency contracting
iii. Reinforcement
iv. Marital counseling
v. Problem solving

Front 29

The family psychoeducational approach

Back 29

approach combines education about the nature of the family member’s illness with other family techniques. Developed by social workers helping those diagnosed with a mental illness and their families. Techniques include cognitive-behavioral techniques, social skills training, and other brief family therapy interventions. This approach has solid research background.

Front 30

Goals of the family psychoeducational approach:

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increase family understanding of the disease, improve family functioning by reducing family members’ expressed emotion and guilt and increase patient medication compliance.

Front 31

Role of therapist in the family psychoeducational approach:

Back 31

educate, connect families with community resources, and provide social skills training or other family therapy techniques as needed. Empowering families and helping to absolved guilt is important as therapist works to motivate, reinforce and encourage families.
i. Assessment
ii. Education
iii. Case management
iv. Family therapy

Front 32

Family Adaptability and Cohesion Scales IV (FACES IV)

Back 32

measures communication and family satisfaction, cohesion and flexibility. 6 scales in total, 7 items on each scale. Very high validity and reliability.

Front 33

Self-Report Family Inventory (SFI)

Back 33

measures family style and competence. Has 5 domains and can be completed by any family member over the age of 11. High validity and reliability.
i. Overall competence (family happiness, optimism, problem solving, parental coalitions)
ii. Behavior and emotional style of functioning (conflict communication, cohesion, leadership, emotional expressions)

Front 34

Family Assessment Measure (FAM)

Back 34

describes how to conduct family assessments based on seven dimensions – affective involvement, control, task accomplishment, role performance, communication, affective expression and values and norms.
Each of these dimensions are measured at three levels: whole family systems, dyadic relationships, and individual functioning.

Front 35

Psychotherapy Integration (PI)

Back 35

Involves the search for and promotion of the most effective psychotherapeutic concepts and methods, regardless of the orientation they originated from. Can be manifested through: intentional employment of common factors, theoretical integration, or methodological eclecticism. Since all psychotherapeutic orientations share certain curative factors, professionals seek to maximize exposure of the client to these factors through methodologically eclectic psychotherapy.

Front 36

Prescriptive psychotherapy

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It encapsulates any methodologically eclectic system of psychotherapy that firmly bases its prescriptive conclusions on empirical rather than theoretical justification. Current emphasis is matching of interventions and/or psychotherapeutic orientations to the diagnosis of the clients in treatment.

Front 37

Multimodal Psychotherapy

Back 37

Type of prescriptive psychotherapy that provides prescriptions based upon an extensive assessment of seven domains of experience.

Front 38

Systematic Treatment Selection

Back 38

Type of prescriptive psychotherapy that is based upon an assessment of key variables such as problem complexity, coping styles, and personality styles, and involves matching general approaches to clients.

Front 39

Stage Appropriate Psychotherapy

Back 39

Type of prescriptive psychotherapy that is based on Prochaska and DiClemente's transtheoretical stages of change. The client's stage of readiness for change is assessed, and approaches are matched to her current stage as it is believed that clients will be most helped when interventions are tailored accordingly.

Front 40

Stages of Change: Precontemplation

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i. Client is not thinking about change
ii. Client believes the consequences of the behavior are not serious
iii. Clients in this stage may only seek treatment when pressured by others.

Front 41

Stages of Change: Contemplation

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i. Client recognizes there is a problem but has not committed to making a change
ii. Clients in this stage may say they are seriously considering change in the near future.

Front 42

Stages of Change: Preparation

Back 42

i. Client is ready to experiment with making small changes
ii. Client may have already attempted to make a change.

Front 43

Stages of Change: Action

Back 43

i. Client is taking action to change
ii. Clients in this stage have successfully changed behavior for a period of time

Front 44

Stages of Change: Maintenance

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i. Client is maintaining behavior changes over time
ii. Client is working to prevent relapse

Front 45

Stages of Change: Relapse

Back 45

i. Relapse is seen as a normal part of the change process
ii. Clients may feel demoralized in this stage
iii. Clients may revert to an earlier stage such as precontemplation
iv. Treatment during this stage attempts to help client view mistakes as an opportunity for learning

Front 46

Tasks for the beginning phase

Back 46

The first two tasks in the beginning phase are to engage families in the helping process and assessing the problem with which the family is struggling. Engagement involves forming a therapeutic alliance between the social worker and the family. Assessment consists of identifying patterns and issues within the family that relate directly to the problem. a. Engagement and assessment are best accomplished in four steps:
i. Make contact with every family member
ii. Define the problem to include perceptions of all members in the family
iii. Establish goals and clarify an intervention process
iv. Contract with the family

Front 47

5 guidelines that suggest a family may be ready to move on from assessment to treatment:

Back 47

i. A good client-practitioner relationship exists
ii. The client feels understood, is ready to commit and is engaging in open communication
iii. An adequate assessment has been conducted
iv. Realistic counseling goals are developed
v. The client is ready to engage in treatment

Front 48

Elements of resistance to treatment:

Back 48

i. View held by family representatives that one of the members is the problem, not the family as a whole. This is often very difficult to overcome.
ii. The view that no problem exists. They may contact you because they are ordered to by school or court, etc. but profess no awareness of the reasons for referral. Sees no need for family participation when its “one persons problem.”

Front 49

Assessment methods

Back 49

comprehensive assessment involves understanding how a family interacts with its environment.

Front 50

Assessment by interviewing

Back 50

Social worker meets with as many family members as possible. During the interviews, social worker uses basic skills, in particular relies on appropriate use of questioning.
i. Topics to address in assessment interviews:
1. Problem
2. Internal family functioning
3. Family life cycle
4. Environment

Front 51

Assessment by observation

Back 51

observation yields information that is essential for understanding families. Unless deliberate use is made of observation, much can be missed. Through independent observation of events in the life of a particular family, the sw can piece together independent viewpoints into a unified whole. Through observation, the sw notices physical characteristics and nonverbal behaviors, energy level, emotions, and congruence between verbal and nonverbal expression.

Front 52

Genogram

Back 52

Looks at historical view (abuse, mental health, alcohol and drug use) family structure relationships and problems)

Front 53

Eco-map

Back 53

places an individual or a family within a social context using circles to represent organizations or factors impacting their lives. Looks at the environment, the strengths and stresses of subsystems

Front 54

Lineal questions

Back 54

asks for information and assumes a basic cause and effect sequence – attempts to define problems and seeks explanation (i.e – what brings you in today? How long have you been experiencing these problems?)

Front 55

Circular questions

Back 55

meant to create change and are aimed at developing explanations for problems and identifying relationships between individuals, ideas, beliefs, and events (i.e – when Melissa said she was upset with you, how did you react? When you hear your husband yelling at the kids, how does that make you feel?)

Front 56

Strategic questions

Back 56

directed at change, based upon the sw assessment of the situation. The underlying intent of strategic questions is to correct behavior – they challenge or confront patterns within the family (i.e – can you try to see it his way? When are you going to tell him what you think?)

Front 57

Reflexive questions

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asks clients to become self-observers, questioning based on the belief that change depends on the efforts of clients, not the sw (i.e – what do you plan on doing about finding a new job? What do you think you can do to improve your school grades?)

Front 58

Defining family and family variations

Back 58

Families can be nuclear, extended, family based cultural, you must look at cultural
Variation- can be origin, procreation (married couple), blended (step), foster, adopted, and single parent.

Front 59

Principles that guide family social work

Back 59

1. Idea that family therapy should be home based. Help family solve their problems. Remember each family is different. You prioritize needs (short term/long term)
2. Idea that change 1 member effects the entire family
3. Whole family is more than just 1 individual
4. Family’s balance change/stability
5. Behaviors are caused by circularity (each individual is effected)
6. Families are effected by communities
7. Families operate by family rules

Front 60

Key Assumptions about family systems and criteria for assessing family functioning

Back 60

Families go thru stages just like an individual does
Each stage requires members to change roles/behaviors
Each stage has tasks
Families can be in multiple stages and have been unable to change in past
Families must be adaptable in order to change

Front 61

Family Developmental Stages-

Back 61

1. Marriage/coupling stage- when family begins
2. Having young children- everything changes
3. School aged children- social support should increase
4. Teens- can be challenging is very difficult than young children
5. Launching- kids go on their own –ex college empty nest syndrome
6. Boomerang- children come back home after leaving
7. Middle age parents- no kids at home, can be grand parents, maybe retiring
8. Aging- parents are older, have aging issues, put stress on their children to care for them

Front 62

Confrontation (as a Intervention Phase Terms)

Back 62

Must be careful when doing this, must have a rapport with client, sometimes client do not see the problem you would help them identify it

Front 63

Reframing (as a Intervention Phase Terms)

Back 63

Help client see and define problem differently

Front 64

Enactment (as a Intervention Phase Terms)

Back 64

Technique utilized to have families interact. You observe roles and behaviors

Front 65

Externalizing (as a Intervention Phase Terms)

Back 65

The client keeps it in, SW takes problem and puts it outside this gives the family more control and ability to focus on the problem

Front 66

Contracting (as a Intervention Phase Terms)

Back 66

is a behavioral approach and is centered on behaviors. Ex. If you do this then I will do that

Front 67

"I" statement (as a Intervention Phase Terms)

Back 67

is a communication skill training that uses active listening.

Front 68

Techniques for interviewing families

Back 68

the fundamental goal of family interviewing is to stimulate interaction among family members. The social worker wants to have the family interact naturally. In a family interview, communication is among family members, should not be between social worker and a member.

Front 69

Attentive listening

Back 69

Attentive listening-concentrating on the client, trying to understand – not trying to evaluate

Front 70

Formulating questions

Back 70

1. Closed-ended versus open-ended-need to know when each is appropriate.
2. Indirect questions – statements that have the same effect as a question
3. Primary and secondary questions – primary introduce new topics, secondary are useful when the client does not respond or responses are incomplete
4. Clarifying questions – enhance communication by requesting additional info
5. Focusing questions – helps clients stay focused and helps clients to identify problems, set priorities and establish goals
6. Probing and prompting – probing uncovers additional info, prompting encourages behavior to develop and continue and is particularly useful when teaching new behaviors

Front 71

Assessing parenting skills

Back 71

Social worker will need to look at the child’s development as well as the history of the parent-child relationship. Look at the following criteria: Degree of attachment, Transmission of values, Absence of rejection, overt or covert and Continuity of care

Front 72

Solutions Therapy

Back 72

Looks at current problem and attempted solutions does not focus on past. Client finds solution

Front 73

Structural Therapy

Back 73

Is a system element approach to the family. Looks at the subsystem, roles, rules, boundaries in the family. Does no look or try to problem solve with the family. Is centered on realigning the structure of the family.

Front 74

Murray Bowen

Back 74

Psychodynamic approach. Focused around enmeshment of families and inability to form attachments/relationships outside the family.

The achievement of separateness, individuality, and autonomy or differentiation of self – is seen in all therapeutic approaches as important to individual and family functioning. It results in giving members a feeling of competence and a sense of empowerment.

Front 75

Behavioral Therapy

Back 75

Focuses on learned behaviors, how to change and look at behaviors. Focuses on that people can change behaviors. Uses positive and negative enforcers to change behaviors. Focuses on skills trainings such as parenting skills, communication skills, modeling behaviors, contracting behaviors between individuals, and often assigns homework for client.

Front 76

Narrative Therapy

Back 76

Client tells their problem through stories. SW helps them reframe, and re-write the story. SW helps them realize there are other alternatives and helps them externalize the problem to have a better sense of it.

Front 77

Virginia Satir

Back 77

Based on structural therapy, Bowen and Erikson. It is centered on communication development. SW helps the client change communication and become more aware of resources and how to utilize them.

Front 78

Salvador Minuchin

Back 78

attributed with development of the structural approach model, the originator of structural family therapy. Studied concepts of enmeshment, engagement.