Theories and Methods - Play Therapy

Play therapy is what it sounds like. Instead of talk being the currency of treatment, clients and therapist engage in play, exploring thoughts, feelings, and conflicts through playing.

The hive mind at Wikipedia adds:

Play therapy is a method of meeting and responding to the mental health needs of children and is extensively acknowledged by experts as an effective and suitable intervention in dealing with children’s brain development. It is generally employed with children aged 3 through 11 and provides a way for them to express their experiences and feelings through a natural, self-guided, self-healing process. As children’s experiences and knowledge are often communicated through play, it becomes an important vehicle for them to know and accept themselves and others.

Find more about how play therapy works and about its origins via this article at Good Therapy.

Will play therapy be on the LCSW exam? You never know. If you've glanced at the above articles, you'll be more than prepared to face a test question if it does. Good luck!

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 https://www.genopro.com/genogram/family-systems-theory/

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.

Theories and Methods - Attachment Theory

Attachment Theory, conceived by John Bowlby and furthered by Mary Ainsworth, explores the centrality of attachment bonds in human development and emotional life. Particular attention is paid to the degree of security infants and children feel in relationship to their caregivers and the consequences when a felt sense of security is lacking (as in cases of even mild emotional neglect). Mary Ainsworth's experimental "strange situation" examined the responses of children to different caregiver behaviors and identified a set of attachment patterns (e.g., anxious-resistant, avoidant...) which followed the children into their adult relationships. Radical when originated, attachment theory has since been thoroughly integrated into much clinical practice, especially that of social workers.

For futher review: Attachment theory at Wikipedia, at Simply Psychology, attachment theory books at Amazon.

Developmental Theory to Know for the Social Work Exam

It seems that straightforward knowledge questions have been phased out of the social work licensing exam over time. You're not likely to see something asking, "The areas in Freud's tripartite theory of personality are:" Too dry, simple, and unsocialworky to make it onto the test. (You know the answer: Superego, Ego, Id.) Be less surprised to see vignettes that draw upon your understanding of various theories, while also testing your basic social work grounding. "A mother brings her 8-year-old to see a social worker reporting [some difficult, upsetting controversial, or otherwise heartbreaking symptom]. A social worker using attachment theory is MOST likely to see these symptoms as:" You've had to weather the impact of the symptoms, keep your eye on what's being asked, and, as a bonus, know something about attachment theory. Answer enough of those correctly, and you're a licensed social worker! Toward that end, here's Wikipedia's list of developmental psychology theories (from the page about developmental psychology, naturally). To lightly review:

• Attachment theory
• Constructivism
• Ecological systems theory
• Psychosexual development
• Stages of moral development
• Stages of psychosocial development
• Theories of cognitive development
• Stages based on the model of hierarchical complexity
• Zone of proximal development
• Evolutionary developmental psychology

It's worth restating here that light review is what's called for. You will not be expected to have deep knowledge about all of the above. The ASWB exam is designed to assess beginning social workers, not PhD candidates (and not psychologists). Adjust your study intensity appropriately. Good luck!

Theories and Methods - Mahler

Margaret Mahler was a Hungarian-born psychoanalyst who worked with disturbed youth and developed the separation-individuation theory of child development. In Mahler's theory, young children pass through a series of stages, each of which has an associated task or action (similar to Erikson's stages that way):

• Normal Autistic Phase (First few weeks of life; achieve equilibrium)
• Normal Symbiotic Phase (Up till around 5 months old; develop dim awareness of caretaker)
• Separation-Individuation Phase (divided into three phases:)
• Hatching (5-10 months; exit autistic shell)
• Practicing (10-16 months; locomotion and accompanying anxiety about separateness)
• Rapprochement (16-24 months; mobility, language, reuniting)

Mahler proposes that, if the process of separation-individuation goes awry, a reliable sense of individual identity in the adult is compromised.

Will Margaret Mahler show up on the social work exam? Don't count on it. But...it's not unheard of. Good luck.

For further review: Margaret Mahler at Wikipedia; chart of stages via PsyEd.org

Theories to Know for the Social Work Exam

Every time an ambitious PhD gets hold of a grant, it seems like a new approach to psychotherapy is born. Which is great, but can be overwhelming. Just look at Wikipedia's list of psychotherapies for a sense of how vast the literature on psychotherapy is. If you're preparing for the social work exam, not to worry. What you might reasonably expect to see appear on the exam doesn't include that whole list. Far from it. The Code of Ethics directs social workers to utilize empirically validated forms of psychotherapy. Social work schools like students to be grounded in the history of psychotherapy. In those two categories, you should be able to locate everything that might possibly show up on the exam, theory-wise. If it's not empirically validated or historically relevant, it might be interesting to learn about, but that's learning that won't necessarily help you on exam day. Here's a quick list of therapy's greatest hits--with links to Wikipedia, pruned from the longer list. A cheat sheet for your exam prep:

• Behavior modification
• Behavior therapy
• Brief psychotherapy
• Client-centered psychotherapy
• Cognitive behavior therapy (CBT)
• Dialectical behavior therapy (DBT)
• Existential therapy
• Family therapy
• Freudian psychotherapy
• Gestalt therapy
• Group therapy
• Motivational interviewing
• Object relations psychotherapy
• Play therapy
• Psychoanalysis
• Psychodynamic psychotherapy
• Rational emotive behavior therapy (REBT)
• Reality therapy
• Rogerian psychotherapy
• Play Therapy
• Solution focused brief therapy
• Systemic therapy
• Transtheoretical model
• Twelve-step programs

Remember not to overstudy. You don't need to know all of these inside and out for the social work exam. You just need a general idea of what's what with each (if that!)--some key concepts and no more. Anything missing? Comments are open.

Theories and Methods - Solution-Focused Therapy

Solution-focused therapy (SFT) is an outcome-focused approach developed by Steve de Shazer, Insoo Kim Berg, and others. SFT is usually brief, always goal directed, and concerned with the future. SFT discards analyzing problems and their origins, instead turning all attention to what can be done. Toward this end, SFT has a handful of signature interventions. The most well-known of these (and most likely to show up on the LCSW exam) is the Miracle Question, which asks, "If you woke up and found your problem (e.g., anxiety, depression, other symptom) was gone, what would be different? How could you tell?" The question elicits specifics from the client that can suggest solutions and/or become goals for therapy. Other SFT interventions include scaling questions, exception-seeking questions, and coping questions. When is a problem worst/best? When is a problem absent? How is it that a client is able to function well in some areas despite the problem? Since solution-focused therapy shares the problem-solving orientation seen in much of social work, it is not unheard of to see SFT questions on the licensing exam.

For further review: Solution-focused brief therapy at Wikipedia, and assorted SFT books via Amazon.

Theories and Methods - DBT

If you're not yet familiar with Dialectical Behavior Therapy (DBT) and are preparing for the social work licensing exam, now's the time to get comfortable with the basics. DBT was developed by Marsha Linehan to help people with Borderline Personality Disorder. Like CBT, DBT is rigorously rooted in research and results. Like CBT, DBT aims to help people with behavioral and cognitive regulation. What DBT adds is a focus on emotional regulation, distress tolerance, acceptance, and mindfulness.

DBT clients learn to use their "wise mind" (the just-right blend of emotion and reason) with the help of a series of acronyms (e.g., "DEAR MAN," and "ACCEPTS")--simple guides to a long list of coping skills. DBT has been shown to be helpful for clients with and without BPD. Given its research orientation, targeted symptoms, and apparent effectiveness, DBT is precisely the type of approach you can expect to see show up on the social work exam.

For further review: DBT at Wikipedia and the Skills Training Manual for Treating Borderline Personality Disorder, by Marsha Linehan.

Theories and Methods - CBT

Cognitive Behavior Therapy (CBT) posits that our experience can be divided into three categories: thoughts, feelings, and behavior. You may have seen a diagram showing all three interlinked. Your behavior influences your thoughts and feelings, your feelings influence your thoughts and behavior, and so on. The primary interventions in CBT look at with what you think and what you do (thus, "cognitive behavior therapy"). The behavioral part has its roots in Skinner and the other behaviorists. Exposure therapy, for example, is a CBT intervention.

The cognitive piece gets the most attention in the CBT literature. The notion is that thoughts are the first stop in our reaction to any given experience. We think, then we feel and act. In CBT, special care is taken to examine those thoughts and determine if they hold up to close scrutiny. Is the thought rational, based in evidence, or not? Irrational thoughts usually are one of several types, included on the list of cognitive distortions (e.g, "mind reading," "fortune telling," "jumping to conclusions").

CBT is practical, interested in evidence, and, more than many other approaches to psychotherapy, has ample evidence showing that it is effective with a wide range of mental health issues (not least, anxiety and depression). For all of these reasons, you can be fairly certain you will encounter questions about CBT on the social work licensing exam.

For further review: Cognitive Behavior Therapy, Basics and Beyond, by Judith Beck.

Theories and Methods - Gestalt Therapy

Gestalt therapy is based on the premise of each individual taking responsibility for the way they relate to others as well as living as an integrated self. Gestalt therapy is closely related to the concept of perception. The person is thought to consist of the self and the self-image. The self is the creative side that seeks to live life in an integrated fashion. The self-image is a dark side that imposes standards that inhibit growth. Maladaptive behavior is considered to be a lack of integration due to an abandoned self. Four disturbances mark Gestalt thoughts on maladaptive behavior: introjection is an overly compliant state where the client incorporates whole concepts without fully understanding them; projection is the disowning of certain parts of the self and attributing them to others; retroflection is the internalization of actions, thoughts, emotions, etc. that are meant for another; finally, confluence, is the abandonment of boundaries between the self and the environment.

The goal of Gestalt therapy is the integration of a unified self. Gestalt therapists use several techniques to achieve this goal. There is a focus on the here-an-now, questioning is discouraged, clients are encouraged to use “I” language to accept responsibility for their actions, clients further encouraged to claim responsibility using overt language, the use of role-playing and the empty-chair technique are designed to help clients externalize internal conflicts, finally, dreamwork is used to examine parts of the self that may not be fully accepted. Gestalt therapy is best used with clients who have the intelligence and education to withstand some of the confrontive techniques it uses.

For further review: Gestalt Therapy Integrated: Contours of Theory & Practice

Theories and Methods - Jung

Jung proposed that libidinal energy was more a general force than a sexual force. Furthermore, while paying attention to the ideas of the conscious and unconscious, Jung also proposed a personal and collective unconscious. The personal unconscious contains our experiences that were once conscious but are now unconscious. The collective unconscious is a vault of memories that is handed down from one generation to the next.

Archetypes are part of the collective unconscious and play a role in personality development. The most important archetypes include: the self, the persona, the shadow, the anima and the animus. Jung also posited four basic psychological functions of which one is generally in use by the conscious at all times. These four basic functions are: thinking, feeling, sensing and intuiting. For Jung, maladaptive behavior consists of a message from the unconscious that something has gone awry or that a task needs to be completed. Jungian therapists rely on interpretations in order to help people bridge the gap between the conscious and the unconscious in order to resolve conflict. Dreamwork and counter-transference also play significant roles in Jungian Analysis.

Theories and Methods - Adler

Adler, initially a disciple of Freud, parted ways with him to form an approach to individual psychology that was teleological and formulated that a person was largely motivated by future goals. Adler’s theory posits four major concepts. Inferiority feelings develop during childhood as a result of real or perceived weaknesses. Striving for superiority is a person’s tendency to move toward perfect completion. The way a person chooses to compensate for their inferiority and strive for superiority results in their style of life. Furthermore, Adler posits two different styles of life, healthy and mistaken. A healthy style of life is reflected through an optimistic outlook and contribution to the welfare of others. On the other hand, a mistaken style of life is marked by self-centeredness and striving for personal power.

Adler believes that maladaptive behavior is the result of taking on a mistaken style of life. In order to combat this Adler believed that therapists should establish a collaborative relationship with the client, understand their style of life, and help the client reorient their beliefs and goals. Adler proposes six techniques to further enhance this process, which include: the lifestyle investigation, study of dreams, interpretation of resistance and transference, role-playing of desired behaviors, paradoxical intentions, and encouragement and advice.

Theories and Methods - Neo-Freudians

The neo-Freudians are more apt to emphasize the role of interpersonal and social environmental factors in the development of personality. While the theorists disagree on the appropriate time to apply this emphasis they would admit that social factors are the primary determinants of personality.

Karen Horney viewed maladaptive behavior as the result of anxiety directly resulting from a child’s interpersonal relationships. Sullivan proposed that cognitive factors played a role in development. He proposed that maladaptive behavior stems from parataxic distortions which involve the client’s inability to perceive a person in the present, instead they are conceived of as a significant person from the past.

Sullivan also thought of the therapist as a participant/observer and expert in interpersonal relationships. His thoughts were that the more people were aware of their interpersonal relationships, the more healthy they became.

Theories and Methods - Object Relations

Object relations theory shares a similar interest in the early development of personality with Freudian theory. However, object relations is more concerned with the self and object relationship (hence the name) than with unconscious drives.

Margaret Mahler’s theory of development is well-known in object relations. Through this theory she posits four stages of development. First there is normal autism which is an undifferentiated state where the infant is oblivious to the external environment. Second is the symbiotic phase the infant recognizes but does not differentiate between the self and the mother. The third phase is differentiation where the child (7 months) separates the self from the other and begins to recognize the differences inherent in each. Finally, the child (2 years old by now) reaches the stage of integration or rapprochement during which the self and the external object are perceived as independent and can have a relationship with one another.

In order to be healthy the child must move through these four stages and develop a coherent idea of self as apart from the other. If the development of early object relations is stunted then the individual will be unable to render the self and the other appropriately and become fixated on an earlier stage of development. The goals of object relations therapy are to provide support, acceptance and opportunity for the client to view themselves and relate to others in a meaningful way.

For further review: Object Relations...in Social Work Practice

Theories and Methods - Ego Analysts

The ego analysts also place an emphasis on the development of the ego for personality characteristics; however, they also see development as taking place across the lifespan rather than just in childhood. Ego analysts view maladaptive behavior as the loss of control by or the assimilation of the ego, which allows the id and superego to run rampant. Ego analysts are more apt to focus on the present and on reparenting the individual, though their techniques of analysis do not differ much from Freudian analysis. Finally, ego analysts focus on the development of functional methods of living in a social reality rather than unconscious drives.

Theories and Methods - Defense Mechanisms

This list is not comprehensive but instead offers an overview of the most common defense mechanisms.

Repression – is the most basic of all defense mechanisms, repression occurs when the drives of the id are forced into the unconscious and denied by the individual

Regression – occurs when a person retreats to a safer earlier stage of development

Projection – happens when a person attributes their own unacceptable needs and drives onto another person.

Reaction Formation – occurs when a person avoids a particular instinct by expressing its opposite.

Displacement – is the transfer of an instinctual drive from one target to a less threatening target.

Sublimation – is the acting out of a socially acceptable behavior as a direct reaction to the drive to do something unacceptable

Denial – is the admission of socially unacceptable impulses joined with the inability to attribute them to oneself

Introjection – is the ascribing of another’s thoughts and behaviors to the self in order to better control one’s own thoughts and behaviors.

Rationalization – is the interpretation of behaviors in a manner that makes them appear more rational or logical

Fixation – is the arresting of libidinal energy in an unresolved conflict

Undoing – is the repetition of a behavior in order to undo the effects of a past action.

Theories and Methods - Brief Psychotherapies

Brief psychotherapy has its roots in psychoanalytic therapy but shares some characteristics with crisis interventions. However, brief psychotherapies are more apt to use catharsis, transference and interpretation as part of the therapeutic milieu.

Rather than seeing the client’s anxiety as situational, these therapies see them as pathological. The therapist takes on a participant observer role rather than being an active participant and focuses on the past rather than the current crisis.

For further review: Brief Dynamic Therapy

Theories and Methods - Crisis Intervention

A crisis manifests as an emotional and/or biophysical upset, or as a cognitive disturbance. Crisis treatment is time-limited and uses a here-and-now orientation and the interventions are concrete. Currently, there are thought to be three types of crisis: Situational, Motivational, and Cultural or societal crisis.

Crises tend to move through five stages: the hazardous event, a vulnerable state, precipitating factor, active crisis, and reintegration. Reintegration and a return to a previous level of functioning are the goals of the therapist using crisis intervention techniques.

Finally, there are several things that can be said about the types of interventions and treatment that are indicative of crisis therapy. In this form of therapy interventions are immediate, concentrate on limited goals, and focus on problem solving. Furthermore, the treatment is active and directive, encourages self-reliance, supports the client, is designed to give hope, and enhances self-esteem.

For further review: Essentials of Crisis Counseling and Intervention (Essentials of Mental Health Practice)

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.