Monday, October 23, 2017

Theories and Methods - Family Systems Theory

Family systems theory may or may not show up on the licensed clinical social work exam. And you may never practice family therapy. But the language of family systems theory can still come in handy, in clinical practice and in life. Take a moment to review.

Family systems theory springs from the work of Murray Bowen (you'll sometimes see it labelled "Bowenian Family Therapy"). It posits that clients cannot be understood on their own, but as a part of a larger system--their family--which is seen as an emotional unit unto itself.

Family roles, rules, boundaries, and patterns are all foci of family systems therapist, who turn to Bowen's eight interlocking concepts as they practice. They are: triangles, differentiation of self, nuclear family emotional systems, family projection process, multigenerational transmission process, emotional cutoff, sibling position, and societal emotional process.

Some of these have entered the vernacular--or, at least, the therapy vernacular. If you see any of them show up on the social work licensing exam, you can know with some confidence that you're facing a question about family systems theory and answer accordingly. Good luck.

For more reading about family systems theory, including quick definitions of the eight interlocking concepts, take a look at

Monday, August 28, 2017

Into the DSM - Schizoaffective Disorder

Schizoaffective disorder readily lends itself to close-call differential diagnosis questions and is a natural favorite for exam writers. A question may boil down to this: Is it schizophrenia or schizoaffective disorder? Well, here are the criteria for schizoaffective disorder:

A. A major mood episode (MDD or manic) concurrent with Criterion A of schizophrenia*
B. Delusions or hallucinations for two or more weeks in the absence of a major mood episode.
C. Symptoms meet criteria for a major mood episode for the majority of the illness.
D. Not attributable to substance or another medical condition.

Bipolar type (that is, psychotic symptoms alongside--but not exclusively during--a manic episode).
Depressive type (same as a above, but with symptoms of MDD).

Remember that psychotic symptoms can be present within bipolar or depressive illness. They can also be present--with the absence of any major mood episodes--in schizophrenia and other psychotic disorders.

That's a lot to have understood before facing down a question about mood/psychotic symptoms. But now you're that much closer to correctly answering a social work exam question on the topic.

For a lot more about schizoaffective disorder, try this long Wikipedia page:

*Here's Criterion A of schizophrenia, referenced above: Two or more of the following present most of the time for a month or more:
  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic behavior
  • Negative symptoms (e.g., blank affect, avolition)

Monday, August 07, 2017

Theories and Methods - Reality Therapy

Reality therapy (RT) was developed in the 1960s by William Glasser. Glasser's view is that people suffer from the human condition rather than mental disorders. RT helps people focus on pursuing their needs, leaving aside discussion of symptoms, the past, and the unconscious--an enormous departure from other, traditional modes of psychotherapy. The focus is here-and-now problem solving and the "three Rs": realism, responsibility, right-and-wrong. In RT treatment, clients aim to identify what they need and develop a workable plan to achieve those ends. The therapist employs a patient, supportive non-judgmental stance.

This is just a quick summary (though probably sufficient for answering a social work exam question). Find much more about reality therapy at Wikipedia and the William Glasser Institute.

Tuesday, June 20, 2017

The Code of Ethics - Social and Political Action

The majority of ethics questions on the LCSW exam are likely to be drawn from the first sections of the NASW Code of Ethics. Informed consent, self-determination, privacy and confidentiality, etc. The bread and butter of ethics question writing. But as you're preparing, take care to read to the end of the code. Section six--last-but-not-least--is Social Workers' Ethical Responsibilities to the Broader Society. The code reaches beyond clients and colleagues into the macro realm. Ethical social workers' focus is expected to extend to social welfare, public participation, help in public emergencies, and into social and political action. Here's the social and political action part in full:
(a) Social workers should engage in social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully. Social workers should be aware of the impact of the political arena on practice and should advocate for changes in policy and legislation to improve social conditions in order to meet basic human needs and promote social justice.
(b) Social workers should act to expand choice and opportunity for all people, with special regard for vulnerable, disadvantaged, oppressed, and exploited people and groups.
(c) Social workers should promote conditions that encourage respect for cultural and social diversity within the United States and globally. Social workers should promote policies and practices that demonstrate respect for difference, support the expansion of cultural knowledge and resources, advocate for programs and institutions that demonstrate cultural competence, and promote policies that safeguard the rights of and confirm equity and social justice for all people.
(d) Social workers should act to prevent and eliminate domination of, exploitation of, and discrimination against any person, group, or class on the basis of race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, or mental or physical disability.
Given that macro issues are filling headlines daily, don't be surprised to see macro questions drawn from section six of the code. If you've got this read and understood, you'll be ready. Good luck!

For more reading on the topic, there's no better place to turn than to the Code of Ethics itself. Enjoy it again.

Tuesday, May 23, 2017

The Code of Ethics - Informed Consent

Here's an essential piece of the NASW Code of Ethics, a favorite of exam writers--section 1.03, Informed Consent. In six quick paragraphs, lots of fodder for LCSW exam questions:

(a) Social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent. Social workers should use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services because of the requirements of a third-party payer, relevant costs, reasonable alternatives, clients’ right to refuse or withdraw consent, and the time frame covered by the consent. Social workers should provide clients with an opportunity to ask questions.
(b) In instances when clients are not literate or have difficulty understanding the primary language used in the practice setting, social workers should take steps to ensure clients’ comprehension. This may include providing clients with a detailed verbal explanation or arranging for a qualified interpreter or translator whenever possible.
(c) In instances when clients lack the capacity to provide informed consent, social workers should protect clients’ interests by seeking permission from an appropriate third party, informing clients consistent with the clients’ level of understanding. In such instances social workers should seek to ensure that the third party acts in a manner consistent with clients’ wishes and interests. Social workers should take reasonable steps to enhance such clients’ ability to give informed consent.
(d) In instances when clients are receiving services involuntarily, social workers should provide information about the nature and extent of services and about the extent of clients’ right to refuse service.
(e) Social workers who provide services via electronic media (such as computer, telephone, radio, and television) should inform recipients of the limitations and risks associated with such services.
(f) Social workers should obtain clients’ informed consent before audiotaping or videotaping clients or permitting observation of services to clients by a third party.
Don't stop with reviewing this one section. Check out the entire Code of Ethics. It's a click away. 

Monday, January 30, 2017

Into the DSM - Narcissistic Personality Disorder

NPD has been thrown around in the news a lot lately. Does that make it any more likely to show up on the social work licensing exam? Hard to say. Exam writers read the news too! Criteria for NPD are:

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.

And that's it. Simple--and difficult--as that. Narcissistic personality disorder is grouped with antisocial personality disorder, borderline personality disorder, and histrionic personality disorder in Cluster B.

Seasoned social workers can usually assess the presence of a personality disorder pretty quickly, without knowing which PD they're facing. The quick summary you'll hear all the time in the field: "Cluster B." On the exam you have to be more certain--know these criteria and how to distinguish from the other personality disorders and you'll be able to correctly answer without too much difficulty.

For further reading, try the Mayo Clinic's NPD page: and Wikipedia's pages, linked here:

Good luck on the exam!