New Information

I was looking at the stats for this website today and it seems as though, on average, 30 people visit the website daily. This is a little surprising to me, since I haven't really updated the content all too frequently. However, it tells me that some people are finding value in what is written here.

I have had an internal debate about what I want to do with this blog. Do I want to just leave it alone and post occasionally (when the mood strikes or an email I receive asks a particular question)? Do I want to make a concerted effort to post more material pertaining to taking the exam? Do I want to work on more exam preparation material?

For me, answering these questions comes down to (1) the service this blog is providing for others and (2) a cost-benefit analysis related to my time. I am writing my dissertation at the moment and that certainly takes up a majority of my time. I know I have asked this before and received a few responses from folks. However, I am asking for your help in determining the direction of this blog. Is what is here enough? Would you like to see more information, and what shape should that information take to be most helpful? The more you can help me understand how you use this blog, the better I can decide where to go in the future.

Thanks,

Minor Additions

I added a few resources to the "Theories and Methods" posts about particular psychotherapies. If there wasn't a good text or the texts were too expensive I didn't bother to add them.

The links will take you to a copy of the book on Amazon with prices and its associated reviews. If you have other resources that would fit with particular theories pass them along and I will try and add them to each list as appropriate.

Thanks for reading.

What would you do first?

These questions are, quite possibly, the most annoying questions on the entire LCSW exam. I remember studying my materials, taking a practice exam, missing numerous questions and scratching my head until it felt like it was bleeding. Invariably, I would wind up missing a few of these "what would you do first" type questions.

The first thing to try and combat my own neuroses about these questions was take them to my supervisor. I would ask him the questions I missed and give him the answers. Interestingly enough we would often agree on the first things we would do, and we would often be wrong according to the materials. How did this seeming exercise in futility help me?

First, it gave me another opinion on the exam. My supervisor was an MSW, DSW and had been in public and private clinical practice for many many years. Hearing his opinion on the question helped me believe in my own gut instincts related to Social Work practice. It also added some perspective to the questions and answers.

Second, our conversations helped me laugh a bit at the exam and alleviate some of the stress and discomfort I was experiencing related to taking the test. Thankfully, we had the kind of supervisory relationship where we were able to talk freely and laugh at both our successes and failures. The relationship provided me an opportunity to study for the exam and understand that Social Work practice is a complex entity that cannot be fully encapsulated in multiple choice questions.

Finally, our conversations helped me reframe the questions so that I could take my incredulity out of my reading of the questions and answer them as best I could. For me, that reframing of the question proved vital. When I would encounter a question that me what I would do first, I would read the question as "Blah, blah, blah, what would the book do first in this situation?" (Usually with the first part of the question replacing the blah, blah, blah). I needed to "divorce" myself from the question so that I could think as the materials would want me to and answer the question appropriately.

So, how might this help you prepare?

(1) If you still have a supervisory relationship, use it for preparation when you have the opportunity. Bounce your missed questions off of the supervisor and learn from their experience in the field. If you don't have this kind of relationship, then find a Social Worker whose practice you admire and sit down with them and ask for their help. You may find that they answer a question the same way you do and you can feel some vindication. They may answer it "correctly" and can help you understand their rationale.

(2) Find a way to put the questions into words that you can stomach. Social work is a wonderful, diverse and complex discipline. Not everyone practices it in the same manner, nor should we. However, the exam attempts to measure your knowledge according to the assumption of a "perfect" world practice. Therefore, we have to put aside some of the methods we have learned and enter a "perfect" world in order to answer the questions as asked. Read the question with whatever reframing you find most helpful, then answer according to your understanding of the study materials you used rather than the experiences you have. Your experiences are important, yet for the exam your ability to study and recall is more important.

Good luck in your studies, I hope this helps.

Peace

5 tips for passing the exam

Reaching the point of taking the LCSW exam is a mixed blessing at best. It means that you have met the requisite hours of practice and supervision, which is a testament to your tenacity and clinical abilities. It also means that a new chapter of studying and anxiety is opened as you prepare to add four new letters behind your name and take a timed test that covers a broad range of topics.
From time to time I will receive emails from people who are preparing to take the exam or who have taken it and not passed. Inevitably, these emails include some request for advice about how to study or prepare for the exam. So, I thought I would cull the advice I have given over the past year or two into one post.
I am not doing this so that you will no longer email me. I do the best I can to respond to each one that I receive. I also know that I will not cover every anxiety or frustration with one post, but for those who like lists and things in a neat little package here are my tips for passing the exam.

1. Think about the way you study best and do that more often. There are a myriad of materials out there to help you prepare for the exams. These range from practice exams to study guides to study guides with practice exams, etc. Most, if not all, of these guides are dry as a bone and merely regurgitate the material you need to know to pass the exam. They have their formulas for getting the material across to you. However, they do not know you best, you do. So, take the materials you choose to study and adapt them to the ways in which you learn. For me, this blog is the result of the way I learn. I needed to re-write the material I was studying in my own words in order to really get a grasp on it. Instead of a pen and paper I took to my laptop and wrote a series of notes that became my study guide. All of the posts on this blog concerning the theories and methods were the result of my homemade study guide. So, think about the ways you learn: flashcards, quizzes, study groups, putting things in your own words, etc. and adapt the study guides to your taste not vice versa.
2. The exam doesn't care how you practice social work. This is one of the hardest lessons to learn and it took me a while to really grasp its meaning. My impression of the exam is that it does not measure real world application of Social Work principles and guidelines; instead, it measures "ideal" (read textbook) applications of these principles. One of the helpful things I took into the exam was a sense that I needed to reframe the questions so that my answers reflected not what I would do first but what "the book" would do first. Therefore, when I encountered a "what would you do first" question I could usually eliminate two of the responses right off the bat. Then I would generally choose the more conservative response from the remaining choices. This may not work for all of these questions but it helped me get into a frame of mind that had me answering questions as the book would want me to answer them rather than the way I think the questions should be answered.
3. The exam measures your ability to remember data. This is not an exam that measures the efficacy of your practice or your ability to help people in a way that empowers them. This exam measures your skills at memorization. Now, I realize this is a fairly cynical view of a standardized test. However, I cannot think of another way to put it. The national exam was created as a method to take the subjectivity of licensure committees out of the process and have an "objective" tool that measures knowledge of social work practice and principles. If you don't pass the first time around, it says absolutely nothing about how good a social worker you are. The only thing a failing score reveals is that you might need more time memorizing the material and putting it to use the way the test wants you to.
   
4. The exam is not always "right." The earlier you give up fighting the questions and their "right" answers, the earlier you can get on with studying the material as needed. I remember studying for the exam and talking with my supervisor about some of the questions and answers. He and I would read some of the questions and talk about how we would answer them given the choices on the test. In each one of these Q&A sessions there would be one or two questions that we would agree on that the test would count as wrong. He had his doctorate in social work and was a successful private practitioner for many years and he still couldn't always get the right answers according to the test. You have to remember that the correct answer for the test may not be your way of answering the question, but it is still the correct answer. Unfortunately, you will not get very far by arguing with the computer over which "answer" you should perform first in a particular situation. Instead, study for the purpose of the exam and remember that the real world is a lot messier than answer A, B, C, or D.
   
5. You have already passed. Remember that the exam is merely the culmination of a long road of clinical practice and supervision. To get to this point in your career you have most likely been through 100 hours of supervision and thousands of hours of clinical practice. Your supervisor has signed off on your capabilities as a social work practitioner. People have come to you for therapeutic help and returned again and again because they believe you can help them. All in all, to get to the point where you can even take the test requires the implicit and explicit approval of a number of people in your life. They know you are a good social worker, regardless of the outcome of your exam. The LCSW exam does not prove that you are a good social worker, that you care about the self-determination of others, or that you stand for justice and provide a voice for the voiceless. Clients wouldn't return if you were a bad social worker, supervisors wouldn't sign the necessary forms if you weren't a good clinician. The fact of the matter is that you have a crowd of people who know that you are ready to take the exam and approve of your doing so. In essence, you have already passed the difficult part; the exam is more a formality than a gate-keeper.

So, there you have it. These five tips helped me put the exam in what I felt was the proper perspective. To be sure, I studied hard and often. However, I was not about to let the exam dictate how I felt about my abilities to practice as a clinical social worker. I merely thought of it as one more step on an already long and most completed journey, a step that affirmed what I already knew from experience. Namely, that I was a good social worker and that I could practice effectively, ethically and compassionately.

Peace

It's Been a While

Occasionally, I get some emails about this blog from the people who find it useful. I have not posted here in a while because of a variety of reasons; however, I could be convinced to post again should the need arise.

Most of what you will find here are brief explanations of the theories and methods of clinical social work practice. My reasons for writing it in the past were twofold. First, it helped me study for my exam. Second, the guides I found online were poorly edited and provided little value for the money you paid for them.

As I think about writing new posts for this blog I am working hard to convince myself of its usefulness for others in need. In that vein, I would ask what you, the people who find this medium and information helpful, would like me to post on this blog. The clinical theories and methods are relatively complete, are there other areas that seem information heavy that could be dealt with here and provide a service to others taking the exam?

What do you think? What information could I provide here that would be helpful for you (and others) taking the LCSW national exam?

If I don't hear anything I will assume that I have provided the necessary information for your benefit. If I do hear something then I will attempt to provide what information I can in as timely a manner as possible.

Feel free to email me or leave a comment in this post.

Peace

Study Groups

I have a request from someone who is looking for others to study with for the LCSW. Rather than post her information individually. Please feel free to comment to this post if you are looking for a study group or know of one in your area. Consider it a bulletin board of sorts...

Better still, post on the more trafficked study group bulletin board at SWTP.

Studying for the Exam

The hardest part about giving advice for the exam is that everyone studies differently and has different needs. However, I will tell you what was helpful to me.

The exam breaks down in this way:

Human growth and development - 22% of the questions
Diagnosis and Assessment - 16%
Clinical Theories and Practice - 16%
Professional Values and Ethics - 10%
Communication - 8%
Therapeutic Relationship - 7%
Diversity - 6%
Service Delivery - 5%
Clinical Practice and Management - 5%
Clinical Supervision, Consultation and Development - 4%
Research - 1%

I spent most of my time working through the first seven things on this list. This blog was my study guide as I wrote and rewrote the theories and methods in my own words.

The first seven categories make up 85% of the exam, and I figured if I knew them well enough to answer most of the questions related to their content accurately then I would have a good chance of passing the exam.

I did not neglect the other portions of the exam, I made sure I knew enough to make an educated guess with relationship to their content and to be relatively sure I would get about half of them right. I can't remember my score exactly, but I believe it was between 78-85, enough to pass in my jurisdiction.

I hope this helps, good luck to all who are taking the exam.

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)

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.