I passed

I took the exam today and passed. I have a great sense of relief and will post the rest of my notes on the theories and other pieces I used as a study guide. I am going on vacation first though...

Theories and Methods - Systems Theory

This theory is often used in the family therapy realm, but generally seeks to describe the interactions between the client and the environment and vice versa. There are two types of systems, open and closed. An open system is deemed functional and is continually interactive with its environment. An open system may become a closed system. This usually occurs when the system attempts to protect itself from the environment, leading to a blockage of energy and isolation which is maladaptive. Systems are prone to change and this is a good thing.

Systems theoreticians believe that systems interact in a way that maintains homeostasis. That is, they behave in a way that is balanced and somewhat flexible towards influence. The homeostatic state of particular systems can have both negative and positive connotations. Systems do what ensures their survival, and often this might include maladaptive behaviors in order to maintain homeostasis. A variety of techniques are used in systems theory to bring about changes. Systems therapists believe in peoples’ capacity and motivation for change.

For further review: There are a variety of books on different variations of family systems theory. Most of the ones I have found are expensive and thus I cannot really recommend a decent reader.

Group Therapy

Group information

This information on group therapy will center on several factors to consider when thinking about the role that group therapy will have in your practice. For a better resource on group therapy, especially group psychotherapy, pick up the latest edition of Theory and Method of Group Psychotherapy by Irving Yalom (I think the 5th edition is the latest). Having been a co-therapist in both a psychotherapy and psycho-educational group I have seen the promises and the difficulties groups can have on the lives of clients.

Three practical considerations concerning groups are: the group, the therapy, and the therapist. Groups tend to work best when the members share similar ages, intelligences and developmental levels. Age is a primary concern with groups for adolescents and children, with developmental level playing a larger role in the adolescent area. Furthermore, gender should play a role in group selection with these age cohorts as well. Finally, there is some discrepancy in thought concerning the role of the problem in selection for a group. Evidence and thought both support homogeneity and heterogeneity.

Groups can also function as closed or open entities. Closed groups are often more task-oriented and function in a short-term fashion. In this form of group, the members are constant from beginning to end. In an open group, members come and go and the group does not really have a specified ending. These groups tend to be more psychotherapeutically oriented. Group size seems to be most effective when it ranges from 7 to 10 members.

Irving Yalom is the leader in theory and method of group psychotherapy. He posits three stages to a group. In the first stage group members are searching for a way to connect with one another and the group as a whole. This stage is dominated by a lack of depth to the communication as the group members feel one another out. In the second stage, group members begin to entrench themselves in particular roles and a social ethos begins to emerge. This stage is marked by an increase in resistance as the members realize they are going to have to “share” the therapist. The final stage is marked by the development of group cohesiveness. Here the group becomes genuine in word and action and a sense of group empathy emerges. Following the establishment of cohesiveness the group matures and much of its “real” work begins. Yalom also believes that the group becomes a small social reality for each individual where they play out their healthy and unhealthy behaviors. Therefore, the group becomes the place where maladaptive behaviors can be tested and reframed in relative safety.

The therapist plays a key role in the group, especially in the beginning stages. The therapist is responsible for creation and maintenance of the group and for building a safe atmosphere for cohesion to emerge. The therapist also keeps the group from wandering too far from its purpose through a gentle nudging back to the present atmosphere of the group. Co-therapists also offer a unique opportunity for group members to see others modeling appropriate behaviors, especially during conflict.

For further review: Theory and Practice of Group Psychotherapy, Fifth Edition

Specific Populations

There are several factors that therapists should be aware of when counseling members of different cultural groups. These factors include: language, acknowledgement of a specific ethic identity, an understanding of how the client views the world, clarity in treatment and goals, recognition of the role that discrimination plays in the lives of culturally diverse populations, be wary of overgeneralizations, encourage clients when discussing differences, and finally don’t assume that all behaviors are dysfunctional because some might derive from culturally significant phenomena.

African-Americans

Without over-generalizing, several ideas should be considered when beginning therapy with an African-American. Therapists should pay heed to a people orientation, the extended family (including church), and a particular form of cultural paranoia. In African-Americans, a healthy form of cultural paranoia exhibits as a reaction of mistrust due to inherent racist structures in the predominant American culture. On the other hand, this must be distinguished from functional paranoia which is the general mistrust of all people and structures. This form of paranoia is seen as maladaptive to the individual.

Some guidelines when working with African-American clients include: adopting a problem-solving approach (such as solution-focused therapy), understanding the systemic influences on particular behaviors, fostering empowerment, attending to nonverbal behaviors, and don’t avoid the issue of racism.

American Indians

Some characteristics that American Indians might share include: a naturalistic outlook that views harmony between humans and nature as a good thing, an emphasis on extended family, present oriented, cooperative, and will listen more often than speak. Therapy can take on a collaborative approach that emphasizes problem-solving while validating the client’s experiences and culture. Trust and flexibility are a must. As well, therapists should understand that particular behaviors may have cultural roots rather than pathological roots. Finally, the use of the community as part of the healing process can be helpful as well.

Asians

When working with the Asian population the therapist can expect the client to understate the problems they are experiencing. Furthermore, modest can be expected as well as difficultly talking about family matters and sexual issues. One source of stress for the immigrant population is assimilation especially at the end of the first year. In addition, conflict between generations and degree of acculturation often occur. The therapist should use a directive approach to alleviate specific symptoms and expect more nonverbal and indirect communication from the client. The therapist should focus on establishing creditability, providing immediate benefit and being aware of issues of shame.

Hispanics

Hispanic clients vary depending on issue of acculturation. They are more likely to emphasize family over individual welfare, focus on interdependence, have difficulty discussing problems, are more concrete, and have “magical” beliefs about God or other powers. Family therapy can be helpful because of its extended reach and multi-focus inventions. Exploring the information that the client shares is important for both rapport and interventions.

Theories and Methods - Existential therapy

Existential therapy is primarily concerned with a growth oriented approach focusing on one’s existence. The therapist uses a person’s struggles with death, isolation, freedom and meaninglessness in order to help the client adapt to life. Anxiety is the result of conflicts that arise between these four realms.

Existentialists view humans as having the capacity for self-awareness, having freedom and responsibility, striving for identity and meaningful relationships, searching for meaning, aware of death and anxious. People are constantly striving for meaning, being and feeling alive and they have the capacity and freedom to make these choices regardless of their circumstances. An existential view of maladaptive behavior takes into account the guilt felt by an individual who chooses not to choose or who have rigid and restrictive ways of thinking and acting.

Existential therapy encourages people to take responsibility for their lives while helping them achieve greater intimacy, interpersonal success, and learn about themselves. The therapist is ultimately hoping to move a client towards a more authentic way of being.

One particular form of existential therapy is logotherapy, which was created by Victor Frankl and focuses on the use of confrontation as a means of creating meaning.

For further review: Existential Psychotherapy, Love's Executioner & Other Tales of Psychotherapy, Man's Search for Meaning

Theories and Methods - Person-centered (Rogerian) therapy

Person-centered therapy assumes that every person is motivated towards self-actualization and positive healthy growth. For Rogers, growth occurs when the self remains unified, whole and organized. Maladaptive behavior surfaces when there is incongruence between the self and one’s experiences. Incongruence is a sense that challenges one’s feelings of worth. It is the feeling that one gets when one believes they are accepted unconditionally, but finds out that people place conditions upon their acceptance. Incongruence produces anxiety which operates defenses and halts self-actualization. The goal of Rogerian therapy is to re-institute congruence between the self and experience.

To this end, there are three important Rogerian techniques. Unconditional positive regard is the genuine care that a therapist offers to a client. Accurate empathic understanding involves the therapist seeing the world through the client’s eyes and sharing that view with the client. Genuineness includes the therapist’s ability to disclose honestly his or her feelings at the appropriate time. Rogerian therapy is non-directive and lacks techniques such as interpretation or assessment. Furthermore, the client is assumed to be the expert on him or herself and the therapist is the witness to the client’s capacity for insight and decision-making.

For further review: The Carl Rogers Reader, On Becoming a Person: A Therapist's View of Psychotherapy

Theories and Methods - Narrative Therapy

In narrative therapy the therapist assumes the role of explorer by gathering and examining the myths and patterns that shape the lives of an individual or family system. The therapist focuses on understanding the client’s experiences and how those experiences create expectations through stories. Our stories influence our views of the present and future and contain the things that we choose to remember and notice in our lives. Life Stories are filter narratives that serve as gatekeepers for our experiences. These stories function to weed out experiences that do not fit the plot of our lives, or alter the experiences until they fit the plot.

Narrative therapy is influenced by social constructionism which states that: realities are socially constructed, constituted through language, organized into narratives, and that there are no meta-truths. Furthermore, therapists in this mould are encouraged to collaborate with clients, search for counter-narratives (those narratives that function in opposition to dysfunctional narratives), use questions for clarification and insight into new stories, and help people author new stories apart from those that derive from culturally dominant sources. The postmodern approach that underlies much of narrative therapy forces the therapist to eschew labels and diagnosis in order to re-humanize the client.

The goal of narrative therapy is the awakening of the client to the experiences before them and the co-authoring of new stories that speak of the way a person wishes to relate to the world. Therapists seek to remove (externalize) the problem from the person so that a separate entity is created and attacked apart from the person. Moreover, through careful use of questions the narrative therapist can get to know the client apart from the problem, further externalize the problem and examine its effects on the person, and help the person re-author dominant stories and deconstruct cultural stories that may hold a person back.

For further review: Maps of Narrative Practice, Narrative Therapy, Narrative Means to Therapeutic Ends

Getting Started

I was asked a question about where to begin when wanting to become licensed as a soical worker. My first thought is begin with your state website. In Colorado (where I currently live) the webiste is found here:

http://www.dora.state.co.us/mental-health/sw/licensing.htm

For other states I would recommend a Google search containing the keywords: social, work, boards, (your state).

Assuming you have completed the required supervisory and clinical hours, the application and payment will need to be filled out and sent in. Then the state board will approve the application and send further instructions for taking the national exam.

Registration for the national exam is through www.aswb.org. Once you are approved you sign up with them, pay another fee, and pick your date and location.

One other place to get information about licensure is through your supervisor or another licensed social worker. It would seem, to me at least, that those who are lisenced and provide supervision should also have information regarding the requirements and steps needed to fulfill the process.

Finally, different states have different concepts of "preparedness." Therefore, check the state website for what you might need before applying. Furthermore, due to a lack of initiative or the inability to agree, there is little reciprocity between states. Therefore, your license in Virginia is no good in Colorado until you fill out the Colorado application, pay the fee, and hope they approve of the work you have already done.