Social work skills for beginning direct practice 3rd edition

Class 1-

Module 7: Discussion Forum

This week’s readings and video introduce a new phenomenon in the field of human services; the use of “non-clinical” interventionalists, referred to as peer support or recovery coaches.

In the video by SAMHSA (found under “Required Readings” for this module), https://www.youtube.com/watch?v=vV0JSZ2k1oQ the experts assert that those in a peer-support role draw on “lived experience” to provide non-clinical, strength-based, reciprocal care to service recipients.

· Provide your reaction to this method of intervention for those living with mental illness and/or substance use disorders.

· Explain how peer support interventions could be used with the client in either Case study 3 or 6 in Appendix E.

· Based on the readings from chapter 11 of the Cummins and Sevel (2017) text, explain at least one additional intervention/treatment approach that should be considered for the selected human services needs.

· Comment on two other classmates’ postings with other ideas about their intervention use.

Readings: Chapter 11

References:

Cummins, L.K. & Sevel, J.A. (2017). Social work skills for beginning direct practice (4th ed.). New York, NY: Pearson.

11.1 Selecting Treatment Options
1. 11.1 Articulate the steps in determining treatment options for a client.

The selection of intervention and treatment modalities should be in alignment with the goals and time frames set out in the contract with the client. Monitoring client responses to treatment interventions will also determine the length of treatment and helps to determine quickly if the treatment mode selected is having the desired effect. It may be necessary to change interventions if a client is not making progress toward his or her goals.

Steps in determining treatment approach:

1. Review the treatment options that are appropriate to the problem identified and the goals set out in the contract.

2. Assess the extent to which treatment interventions are supported by evidence of their effectiveness (evidence-based practice).

3. Identify the interventions and techniques that best fit the client's need.

4. Do an honest self-assessment of your practice skill set and determine whether you are qualified to institute the intervention, whether you will need to implement the treatment under the supervision of a more experienced and competent practitioner, or whether the client should be referred to another social worker more qualified to provide the selected treatment.

11.2 The Context of Treatment and Intervention
11.2 Describe the cultural and agency contexts of treatment.

Treatment applications should vary from client to client and take into consideration the context of the problem being addressed and the treatment application. Contextual factors can include the emotional and psychological states of the client, the client's intellectual/cognitive abilities, cultural beliefs and practices (as well as cultural taboos), agency rules and practice orientation, treatment setting (agency, client's home, school, or community setting), family context, and social support networks.

11.2.1 Cultural Context

As a social worker treating diverse client groups, it is vital to be aware of the visible and nonvisible cultural aspects of your clients' lives. While gender and ethnicity may be the more apparent cultural features when first meeting a client, other values and cultural aspects of a client's life are equally important to your work together and in building culturally appropriate and competent methods of intervention. For example, sexual orientation, spiritual or religious practices, political persuasions, and general philosophy of life are cultural elements you may need to discover about your client and incorporate into your treatment and intervention methods. Likewise, to the extent that your client's personal culture is an extension of his or her family and community culture, the use of these resources and networks in the treatment and intervention phase should be thoughtfully selected and instituted.

Comprehensive cultural knowledge of your client is necessary when selecting and applying appropriate intervention methods. For example, a client experiencing problems with intimacy in his or her life may benefit from an exercise that requires the client to make prolonged eye contact with the social worker with the intent of "seeing" the other's essence or inner goodness and bonding with the social worker. While this technique would be appropriate for problems of intimacy, it would not be appropriate in cultures where eye contact is considered bold, confronting, or disrespectful, as in the Japanese culture.

11.2.2 Internal Culture—Psychological, Emotional, Cognitive, and Intellectual Capabilities/Limitations of the Client

The completion of multidimensional assessment gives the social worker insight into the internal culture of the client. This knowledge will help the social worker select a treatment intervention that is well matched with the client's capabilities while building on client strengths and minimizing their challenges. For example, an unemployed client presenting with irrational thoughts, cognitive distortions, and rigid thought patterns may need an intervention that gently challenges these cognitive limitations (cognitive restructuring) and that consequently opens up opportunities for the client to engage in employment interviews in a manner that exposes his or her talents, skills, and qualifications for the jobs rather than in ways that reflect his or her unrealistic and fearful thoughts. This then may lead to accomplishing a short-term contract goal, such as "complete three successful job interviews by the end of three weeks," or a long-term goal, such as "find appropriate employment that utilizes client strengths within six months." Cognitive interventions concentrate on helping the client achieve rational linkages between external events in the client's life and the thoughts and behaviors that the external events generate (Walsh, 2013).

Emotional health is closely tied to cognitive health. Emotions are a reaction to our thoughts and interpretations of events (Sheafor & Horejsi, 2012; Walsh, 2013). To the extent that these fall within the realm of rational thinking, emotions follow suit, as do behaviors, because emotions influence and direct our behavior. Just as we have thought patterns, so too we have emotional patterns. Emotional responses to events should be appropriate to the event; laughter in response to a happy event should be consistent and predictable and within the range of feeling responses. Smiling and giving a light chuckle to a baby blowing bubbles would seem appropriate, while bursting into tears and having to leave the room might suggest some emotional health issues. For example, the sight of a joyful baby to someone who has recently suffered a loss of a child or grandchild could open fresh wounds and cause a tearful reaction.

When selecting a treatment intervention for a client, be cognizant of the client's emotional functioning around the problem being addressed and the meaning and emotions attached to the problem. For example, a client who presents with great shame around a sexual assault she experienced may not be a good candidate for a survivor of a rape/sexual assault support group at the outset of your work together. This may be a long-term treatment goal that you work toward after the client has had a response to a treatment method that provides her the freedom to express her rage about the event and to begin to see herself not as the cause of the rape but, rather, as the person who was injured as a result of the aggressive act.

Finally, when working with clients who are developmentally and intellectually challenged, it is important to use interventions that match their physical, cognitive, and emotional developmental levels. When in doubt, refer back to your assessment in these areas and work with a supervisor to guide you in this area of practice.

11.2.3 Agency Context

Agencies have cultures that are driven by their philosophy of service delivery, their mission statement, and the vision of their role in the community. The community setting may also influence the culture of an agency and the people who work there. As social workers, we bring our own cultures and life experiences to the agency, thus adding another layer to the agency culture . Some agencies are more flexible in their cultural development, changing or expanding over time in response to community and client needs. Alternatively, clients and workers may experience some agencies as more rigid and static in their culture, holding onto original values, beliefs, and practices on which the organization was founded. Some agencies may be perceived as more open and inviting, while others may be more closed and private. Both types of cultures may be appropriate, depending on the client base that the agency serves. For example, an agency that provides protection and temporary housing and counseling services to victims of domestic violence will best serve its clients by securing a location that is not publicly known and that is physically and emotionally secure. Providing treatment interventions within this agency culture will dictate that treatments selected be in line with the psychological and emotional needs of the client and be delivered within the context of the agency. A new client recently released from the hospital and recovering from severe traumatic injuries incurred from a domestic battery will need the safety of the domestic shelter and the calm of a quiet, safe space while healing.

In contrast to a closed agency, an open and easily accessible agency may be experienced as more inviting by clients and community members. For example, an agency serving academically at risk children and their families would do well to have an open and inviting environment that provides a play area for children, an information center on other resources available in the community, and even a communal kitchen where snacks are served to children attending after-school programs.

Finally, some agencies have a preferred theoretical approach to treating their client base. For example, some agencies may be invested in cognitive restructuring treatments for addressing the anxiety issues of their clients, while another may prefer the use of psychoanalytical approaches, such as brief psychodynamic therapy. The treatment preferences and practices of your agency may limit your selection of options or at best make it difficult to institute interventions not commonly used in your agency setting. The extent to which your agency is open and flexible to new ideas and treatments will determine the ease with which you will be able to expand the repertoire of treatment options within your agency and provide a wider range of interventions for your clients.

11.3 Client Motivation in Treatment

11.3 Distinguish the central concepts of motivational interviewing.

What motivates clients to actively engage in treatment? Whose responsibility is it to make sure the client becomes invested and remains engaged in treatment? The transactional understanding of motivation sees it as coming from the client's inner world and also from the experiences in his or her outer world as he or she interacts with the social worker and others in the service delivery system. To the extent that these interactions are uplifting and empowering, the client is provided with hope and reasons to be motivated. This conception of transactional motivation has support from prominent theories used in social work practice, such as systems theory, cognitive-behavioral theories, and symbolic interactionism (Ellis, 1991; Ritzer, 2013). Further responsibility of keeping the client motivated and engaged is shared by the client, the social worker, and the system of care (Miley, O'Melia, & DuBois, 2013). Client motivation is important not only because it keeps the client engaged in treatment but also because we know from intervention research that when client and social worker motivations are focused in the same direction and in agreement with treatment methods and time lines, client outcomes improve (Del Rea, Flückigerc, Horvathd, Symondse, & Wampoldf, 2012; Hogue, Dauber, Cecero, Stambaugh, & Liddle, 2006; Meissner, 2007). This social worker–client alignment is referred to as therapeutic alliance.

11.3.1 Client Resistance in Treatment

Resistance to change is a common human response, even when the client has a desire for change. Unfamiliar territory can raise anxiety and fears in clients. Understanding those fears and the meaning they have for clients can help the social worker lead the client into the treatment phase. Setting a comfortable pace for the progression of treatment can also help ease client fears and resistance until the client has become accustomed to the first signs of change. When resistance occurs, look to see where you and the client are not in alignment and where adjustments need to be made. This may be in relation to the time line of the intervention, the direction of the intervention, or some new issue you have yet to learn about from the client, as in the case of Mrs. Kita in Interactive Case Study #5

11.3.2 Motivational Interviewing

What we have consistently observed and learned about clients over time is that how the social worker interacts with clients has a direct and significant impact on client motivation and levels of resistance to change (Miller & Rollnick, 2013; Wahab, 2005). Motivational interviewing builds on this wisdom and through the use of empathy accepts resistance as a normal dynamic in the helping process. Motivational interviewing is a specific brief therapeutic approach used to help clients resolve resistance or ambivalence toward change, recognizing that clients come to the helping process with different levels of readiness to change. When using motivational interviewing, a major function of the social worker is to help the client work through his or her ambivalence by raising awareness of the implications of changing versus not changing. Collaboration between the social worker and the client is a foundational element of motivational interviewing. Through this collaboration, clients grow in self-efficacy and thus self-confidence in their ability to change (Lundahl, Kunz, Brownell, Tollefson, & Burke, 2010; Walsh, 2013).

Social work practitioners trained in using motivational interviewing work from four tenets of practice:

1. Expressing empathy to clients—this deepens the rapport with clients and reduces resistance to change.

2. Developing discrepancies—the client is allowed to argue against change while the social worker raises awareness of the client's current problem. Ultimately, the client sees the discrepancies between his or her stated position/beliefs/values and the problems he or she is currently experiencing.

3. Rolling with resistance—there is acceptance of the client's resistance; the social worker understands it as a normal part of the helping process.

4. Supporting client's self-efficacy—here the social worker acknowledges the client's ability to change (Lundahl et al., 2010).

While motivational interviewing emerged out of the substance abuse field of practice, it has proven to be particularly effective with clients who are reluctant to acknowledge and actively address problems (Lundahl et al., 2010; Walsh, 2013). Motivational interviewing incorporates many theories used in social work practice, but the most notable are Rogerian theory, cognitive theory, and the transtheoretical model of change. Because of its emphasis on acceptance, empathy, a nonjudgmental approach, and belief in client autonomy and self-determination, motivational interviewing has a good fit with the profession and values of social work. The 'theory into practice' example below presents a case study and social worker–client dialogue that demonstrate the application of motivational interviewing and its usefulness in engaging clients. In this case study, the social worker helps the client, Tania, consider discrepancies in her beliefs, values, and perspectives.

11.5 Brief Treatment Strategies and Techniques: Examples from Psychodynamic, Cognitive-Behavioral, and Postmodern Theoretical Perspectives

1. 11.5 Link specific practice theories to specific brief therapies prominent in social work practice.

Brief treatment with clients has become the norm in recent years, as constraints of third-party insurance payments have limited the number of therapeutic sessions. In addition, new forms of therapies that bear quick results have proven effective in relieving client symptoms, making brief therapies the treatment of choice in many cases. Practice theories support distinct therapies in social work practice. In this section, brief therapies are selected from categories of theory to demonstrate the types of interventions commonly used in social work practice and to link the specific practice theories to practice interventions.

In social work practice, it is usual to have a blending of theories that direct treatment with clients while having one theoretical perspective dominate the treatment phase. For example, many psychodynamic therapists also incorporate cognitive-behavioral techniques into their treatment with clients. Elements of humanistic client-centered interventions are universal in their use with other therapeutic approaches and are observable across most clinical interventions. Regardless of theoretical and practice approach, it is universally recognized that clients respond better to treatment when they feel heard, accepted, and received with nonjudgmental, unconditional regard.

Class 2-

Module 7: Discussion Forum

Ethical Reasoning, Values, and Critical Reasoning

This week’s discussion question asks you to draw upon the interactive lecture and readings for this week and address two of the following four questions regarding concepts of ethical reasoning:

1. What is the essential basis for ethical reasoning, according to Paul and Elder? Why are ethical principles not a matter of subjective preference?

2. How might reasoning processes be used to achieve unethical goals? What examples of this have you witnessed in your personal or professional life?

3. What are some challenges of moral absolutism and moral relativism?

4. How do you assess religious ideals as a source of value and ethics? How would Azlin Puteh Salin, Ab Manan, Kamaluddin, and Nawawi (2017) argue for specific types of religious ethics as a means to think critically? Why might Norenzayan (2014) challenge their thinking?

Requirements for Discussion Boards:

· Utilize and interface with the required readings to analyze and engage the discussion board questions.

· Your initial post should be concise and to the point and be supported by the required readings. Be sure to include a reference in each post, including peer responses.

Readings

Reference: Paul, R. & Elder, L. (2012). Critical Thinking. 3rd Edition. Boston, MA: Pearson

1: Core Ideas and Principles in Ethical Reasoning
The ultimate basis for ethical reasoning is "thinking through problems or issues that entail implications for harming or helping sentient creatures"(Paul & Elder, 2012, p. 445).

Ethical reasoning is a domain of thinking that is independent of religious or cultural norms. Ethical reasoners seek to uncover ethical concepts that promote cooperative societies for the sustainable welfare and advancement of all people. Thus, we approach ethical reasoning as a cultivation of reasoning abilities that we can apply to ethical issues, keeping in mind that the essential basis for this reasoning must be the implications for harming or helping sentient creatures.

Foundations for Ethical Reasoning

The following are adapted from Paul and Elder (2012) as the foundations required for ethical reasoning. Click each number to review them.

Ethical principles are not subjective preferences.

Ethical principles cannot be confused with our subjective preferences. While ethical judgments may be based on our religious or cultural beliefs or political ideologies, these judgements are often a mixture of our own belief systems and vested interests. Ethical reasoning is not an imposition of our beliefs on others.

If someone does not hold the same religious beliefs as we do, or have the same political point of view, this is not a reason to demonize the person for not agreeing with our perspective. Ethical reasoning, instead, considers how our choices and decisions may harm or provide benefit for others. Ethical reasoning requires self-mastery and self-critique and a consideration of the intellectual traits we have discussed throughout the course such as intellectual humility, intellectual integrity and fair-mindedness.

Paul and Elder (2012) emphasize the intellectual traits, standards, and the elements of reason as a foundation for thinking about how we ought to act, how our character should be formed, and which intellectual virtues we should develop. They argue that ethical reasoning can be difficult because we often wish to honor social norms, family customs, and our own personal desires. And, they argue that ethical reasoning is distinct from all other domains of human thinking. Thus, ethical reasoning is different from legal reasoning, religious teachings, and social norms. Although such domains clearly overlap, ethical reasoning is given its own privileged position in their framework of thinking.

The Challenges of Ethical Reasoning

The United Nations' Declaration of Human Rights, which has been ratified by all countries, asserts universal ethical principles. Even though we can all agree on these principles at an abstract level, the challenge is that at the level of action, this agreement has not yet produced a world that honors human rights. According to Paul and Elder (2012):

There are too many ways by which humans can rationalize their rapacious desires and feel self-justified in taking advantage of those who are weaker or less able to protect themselves. Too many forces in human life -- social groups, religions, political ideologies -- generate norms of right and wrong that ignore or distort ethical principles. What's more, humans are too skilled in the art of self-deception for mere verbal agreement on abstract ethical principles to translate into the reality of an ethically just world. (p. 347)

Basic Concepts

Morals and ethics are concepts often used interchangeably (and we will do so for the purposes of this lecture).

Morals

Morals are usually thought of as abstract, personal, and subjective in nature. If someone has a lapse of "moral judgement," they have violated some principle of conscience or judgment that forms their understanding of how they should act.

Ethics

Ethics are usually more practical and professional in nature: lawyers practice legal ethics and doctors’ practice medical ethics. Judgments about what constitutes "ethical behavior" in these contexts are often based on shared ideas of fairness or other ideals that emerge in business, legal, medical, or other professional settings

Some individuals confuse ethical reasoning with etiquette. Etiquette is defined in the Merriam-Webster dictionary as "the conduct or procedure required by good breeding or prescribed by authority to be observed in social or official life" ("Etiquette", n.d., para. 1). Standards of etiquette are often performed without clear reasons, or they reflect cultural contexts and surroundings. In the 1800s, it was considered bad etiquette to drive one's carriage past another carriage when traveling in the same direction. The reasoning behind this was sound—the dust kicked up by the passing carriage was offensive to those being passed.

Values are "standards or ideals with which we evaluate actions, people, things, or situations" (Lau & Chan, 2017b, para. 1). Values such as patience, kindness, honesty, and justice can help us plan, deliberate, and reason about complex moral and ethical issues.

Ethical reasoning also categorizes human actions using distinctions such as ends and means to gain clarity.

1.2: Does Religion Make People Moral?

When we use the term "religion," we think we know what this means. However, our understanding probably has more to do with our own particular religious beliefs than it does with what religion really is and what it does. As ethical reasoners, we recognize that not only are there a wide variety of religious beliefs, but that these beliefs are culturally variable, and that they are subject to unlimited theological debate.

For a discussion on religion and morality, see this instructive tutorial from Lau and Chan (2017).

In one of the required readings for this week - Does Religion Make People Moral? - Noranzayan (2014) argued that although prosocial religions have certainly created important cultural solutions, they have not necessarily created moral societies in all contexts; many secular initiatives have also successfully promoted large scale cooperation and trust.

The philosopher Kwame Anthony Appiah argues that in order to reason well about religion, we must be able to define and understand what religion is and what it does. This reiterates Noranzayan's point that religion "is not a natural kind category or a definable concept, therefore semantic debates about how to define religion are not scientifically productive" (Noranzayan, 2014, p. 368). Both Appiah and Noranzayan would agree that religion is a complex and culturally related set of beliefs and behaviors that evolve over historical time in different contexts and that it acts to provide a social fabric that binds people together. You are encouraged to watch Appiah's TedTalk " Is Religion Good or Bad? (This is a trick question) ," which can be accessed in this course's Video Supplement Guide in the Course Resources folder.