This page is intended to help Social Workers who are in course of taking up their graduate or licensing exam. It contains information collected and compiled from public domain, personal experience in working towards the exam,information regarding the subjects and tips.This page is created with the help of my guardian angel to help others who feel lost and a personal experience of a God centered person who enters SW profession
Showing posts with label Assessment and intervention planning. Show all posts
Showing posts with label Assessment and intervention planning. Show all posts
Social Workers who are group members are qualified to carry out 3 tasks that can be very useful for the group in its functioning:
Consultation : to ask for and offer information and suggestions. it does not demand that the suggestion be accepted. it provides an expectation that all group members will examine the information and suggestion in the light of the social workers contribution. this encourages the group to engage in style of joint assessment of clients in situations and for considering alternatives for developing solutions to problems and plan of action.
Facilitation - it is a task that enables others to function. facilitation of the group process is one form of this task. SWrks can carry this in a number of ways. they can support the helpful behaviors of other group members, model useful behaviors, ask appropriate questions, or provide appropriate observations about the observations and feelings about the group. they can teach other group members about group processes and functioning. other means of facilitation are helping members stay on the topic, summarizing what has been said or decided and letting other members know their feelings are OK.some behaviors to avoid are criticizing others or their values, forcing ideas on group, making decisions that belong to the group, talking too much. the social worker studies the group and its functioning and decided what will most help the group at any point in a given time.
Coordination - this task calls for monitoring to learn if all members are carrying out their assigned tasks and that, in carrying out of the tasks, the work of each group member is done in a way that complements those of other members. . it is a task of insuring that the work of other members do not conflict but complements other members. much of this task is done b y building relationships. the social worker attempts to understand the position of every other group member and to gain an appreciation of the needs of each member in relation to the group task.
The worker group interaction happens in a number of ways including :
through acceptance
through relationships
through enabling and supporting
through limiting behavior
through guiding
through alleviation
through interpreting
through observation and evaluation
through planning and preparation
the role of the social worker with the group is to help the members reach out to one another in such a way that they can help one another in meeting the needs of individual group members and in some way influence the environment so that group and individual needs are better met. The social workers role is influenced by the stage of group development and the stage of individual member development in the process.
Group member/client roles in group work
All groups whether therapeutic or problem solving whatever the objective might be require that both task roles and group building roles are performed satisfactorily. And these roles rely on members performing various roles in a group. this helps to strengthen the social, emotional aspects of group life. Johnson and Johnson summarized these roles as follows :
Information and opinion giver
information and opinion seeker
starter
direction giver
summarizer
coordinator
diagonizer
energizer
reality tester
evaluator
Group maintenance roles such as :
encourager of participation
harmonizer and compromiser
tension reliever
communication helper
evaluator of emotional climate
process observer
standard setter
active listener
trust builder
interpersonal problem solver
Reference :
Social Work Practice a generalist approach by Loiuse C Johnson, pg: 205
The practice of social work by charles zastrow, pg:146
Factors that encourage group development include :
strength of members commitment to the groups functions, tasks and goals
the satisfaction of the mutual needs of the members
the liking or caring the members feel for one another
reciprocation rather than competition for goals
respect for diversity among group members
the amount of time the group spends together
interaction that encourages individual growth
a degree of homogeneity and heterogeneity
According to Louise C johnson the stages of Group Development may be conceptualized as follows :
The Orientation Phase : members come together for the first time and seek similarities in interest. there is initial contentment to the group. also an approach avoidance mechanism at work, task roles begin to emerge, patterns of functioning around tasks begin o develop. individuals are making decisions about the desirability of belonging to the group and whether to become dependent on other group members.
The authority stage - challenge to influence and control the group by individual members. conflict develops. structure and patterns of functioning are revised, norms and values develop
the negotiation stage - the group confronts, engages and differs in conflict resolution. goals, roles, tasks are designated and accepted. group cohesion is stronger and members are freer in sharing information and opinion.
The functional stage - high level of group integration is achieved, little conflict about structure and ways of functioning has been established. roles are differentially assigned to members which are accepted by all. the group has the capacity to change and adapt. the goals are reached and the group can evaluate itself.
the disintegration stage- at any of the first four stages, a group may begin to disintegrate. signs include lessening of bond, reduction in the frequency of group interraction and strength of influence on members.
Groups change over time. few models or frameworks that describe group change are:
Garland Jones and kolodny model 5 stages of development
this model describes problems that commonly arise as groups form and develop. understanding these problems, it is theorized , enables leader ot respond to member more effectively. . this model is particularly applicable to socialization groups (where there is need for change in attitude and behavior), therapy groups and encounter or sensitive groups.
Closeness is the central focus of this model. the question of focus is reflected in the struggle that occurs at the five stages of group growth.
Pre affiliation :
members are ambivalent about joining the group
interaction is guarded
members test through avoidance and approach behavior whether they really want to belong to the group
new situations are frightening and members protect themselves being hurt or taken advantage of.
they attempt to maintain a certain amount of distance and get what they can get without taking any risk.
individuals are aware that group involvement will make demands that may be frustrating or even painful, however they are also attracted to the group because they have also had satisfying experiences with previous groups
in the first stage the leader should seek to increase the members attraction to the group by allowing and supporting distance, gently inviting trust, facilitating exploration of the physical and psychological mileu, and by providing activities if necessary and by initiating group structure.
the first stage gradually ends as members start to feel fairly safe and comfortable and view the rewards as worth a tentative emotional commitment.
Power and control :
emerges as group characteristics begin to develop.
patterns of communication begin, subgroups appear, members take on certain roles and responsibilities, norms and methods for handling tasks develop, and membership questions arise. such processes occur as the groups begin to conduct its business however these processes lead to struggle as the members establish their places in the group
each member seeks power partly for self protection and partly to gain greater control over the gratifications and rewards to be received from the group.
in this struggle the group leader is the major source of gratification. the leader is perceived to have to greater power to influence the groups direction and to give or withhold emotional or material rewards.
at this point members realize the group is becoming important to them
in this stage the limits of control and power is questioned. is it leader or the group. drop out rates are highest at this stage.
during this struggle leaders should help the members understand the nature of power struggle, give emotional support, help the group establish norm to resolve uncertainty.
it is very important that the leader develops trust in this stage and can maintain a balance of shared power and control, when trust is achieved members take major commitment and become involved in group.
intimacy :
likes and dislikes are expressed
group is referred to as family where sibling rivalry arise between members and group leader is often looked upon as parent
feelings about the group at this stage are more openly discussed or expressed
the group is now viewed as a place where growth and change takes place. individuals examine and make efforts to change personal attitudes, concerns and problems
group tasks are worked on and there is a feeling of oneness and cohesiveness
struggle or turmoil in this stage leads members to explore and make changes in personal lives
differentiation :
members increasingly experiment with new and alternative behavior patterns
there is a recognition of individual rights and needs and there is a high level of communication among group members
the group is able to organize itself more efficiently
leadership is shared and roles are more functional
power problems are now minimal and decisions are made with less emotion and on a more objective basis
separation :
the purposes of the group have been achieved, and members have learned new behavioral patterns that enable them to move on to other social experiences.
termination is not always easy
members are sometimes reluctant to move on and may display regressive behavior in an effort to prolong the safety of the group. they may also express anger over ending the group or even psychologically deny the end is near
Tuckman Model
tuckman reviewed more than 50 studies of therapy and sensitivity groups with limited duration and concluded that groups go through the following stages :
Forming - members become oriented toward each other , work on being accepted and learn more about the group. a period of uncertainty ensues where members try to determine their place in the group
Storming- conflicts begin to arise as members resist the influence of the group and rebel against accomplishing the task
Norming- the group establishes cohesiveness and commitment and in the process group members discover new ways to work together. norms are also set for appropriate behavior
Performing - the group works as a unit to achieve the group's goals. the group develops proficiency in achieving its goals and becomes more flexible in its patterns of working together
Adjourning- the group disbands. the feelings that members experience are similar to those expressed in separation " stage in previous model.
Bales Model
this is a recurring phase model of group development. he ascertained that groups continue to seek an equilibrium between task oriented work and emotional expressions to build better relationships among members. groups tend to oscillate between these two concerns. between achieving goals and at times focussing on emotional or morale
Reference :
The Practice of Social Work by charles zastrow pg 144
preparation ensure the level of success of group encounter
prepare based on what are the purpose/goals of group
what possible ways can the general goals be achieved
what are the characteristics of members
what resources are needed
what should the agenda be for first meeting
when the group first meets, should an ice breaker exercise be used?
how should chairs be arranged? refreshments provided? what do members expect you to do
check the group members and their characteristics ie sex, age, ethnic background, education etc
understanding self and members in general
how well I, a leader can make the group feel comfortable and accepted as leader
After the first meeting has occurred, its good to review how things went compared to the plan laid. some questions which would help to review this include :
have the goals been clarified to members
are we making adequate progress in accomplishing goals
if not what obstacles are slowing down the group in meeting the goals
have we selected adequate courses of action to reach the goal
what items should be in agenda for next meeting?
will successful completion of activities help us accomplish in achieving the goals
is each member interested and motivated in achieving or working towards accomplishing the goal
if they are disinterested, whats the reason and what could stimulate their interests
II. Session planning
planning a session is very essential to keep in pace with moving towards group goals. it is essential to identify specific goals for each session which should be in line with helping to achieve the overall goal og the group. some suggestions include :
select relevant content
use examples to support points or opinion, like statistics, reports, news etc
present materials in a logical order
plan the time
be flexible with the agenda
be creative in handling : use different pace in presenting, use different medium to present whi ch will involve, engage or interests the group, give breaks, include discussion, invite guest speaker, conduct games etc
III. Relaxing before a meeting
effective group leaders reduce anxiety before leading a group using relaxation techniques. practice in leading groups will gain confidence as well.
IV. cues on entering the meeting room
be punctual - as a leader you set an example to the group
make sure things are arranged before members arrive
seated before everyone comes helps leader with some time to observe members and their mood and reaction, interest, knowing more about the population involved
notice cues to join with the group by observing or capturing their interests and other cues they give verbally and non verbally, directly or indirectly
V. Seating arrangements
seating arrangement is very important and influences a lot of aspects in the group process like group cohesion, morale etc
seating arrangement should be in such a way where the leader can have eye contact with every member in the group, also between each other group members.
a circle is ideal for various aspects such as openness and cohesion
tables act as a a subtle barrier to communication. therapy groups seldom use tables.
the shape of the table influences the communication between group members too
encourage members to get to know each other since each gets comfortable with a particular person and may form friends and may not want to sit with someone else from next session on.
VI. Introductions
both leader and members introduction is very important and sometimes this process itself acts as an ice breaker
the leader must express oneself along with his credentials in a non arrogant manner, so the group does not experience superiority rather expertise
deliver the message in an appropriate way either fun or serious, formal or informal
learn members name as quickly as possible
name tags help, but to know each and every member helps leader to better know and communicate
members appreciate being called by name and the feeling that the leader is giving attention to them helps in cohesion
ice breaker for members introduction should be helpful
members can state their expectations of group in this stage so its easy for the leader to do the necessary clarifications
VII. Role clarification
the roles that leaders assume in a group varies from situation to situation
clarify roles of leaders and members
discuss on role expectation and get members opinions
members tend to participate more when they are allowed to contribute more and feel as a part of the group psychologically
jot down each members responsibility and the leaders as well and how this helps in achieving the common group goal
the leader should explain clearly when the expectations cannot be met, being humle about skills and credentials helps in groups acceptance of leader's opinions
be prepared to explain reasoning behind things you do as a leader
VIII. Agenda
all group members should have opportunity to suggest agendas. if possible sommunicate the agendas several days before the meeting so the members will have chance to go through and discuss when they come for the meeting. so during the meeting the members have chance to discuss deletions, additions, corrections appropriate and vote and decide on the agenda
IX. Additional guidelines for leading a group
leadership is a shared responsibility, every member of the group should get a chance to lead the group however not in a controlling manner
use decision making process that are best suited for the issues facing the group
create a cooperative group atmosphere rather a competitive group atmosphere
view controversy and conflict as natural and desirable for resolving issues and furthering discussion
use a problem solving approach rather a win lose approach
give attention to how you end the session. a few minutes before the meeting is scheduled to end, or when it seems that the group is exhausted conclude with a brief summary the key points made in the meeting. this leaves them with a sense of achievement
X. Terminating a group
This is a process of separating from the group and from the members. Separation typically involves mixed feelings that vary in intensity according to number of factors. the greater the members emotional cloness and investment in the group the greater the feeling of loss. there are several types of termination:
Termination of a successful group- this refers to the group which has accomplished its goals. this generates a sweetness sorrow feeling among members. they are delighted with their accomplishment which increase their self confidence and self esteem. in such groups formal terminations may begin one or more meetings before the final one. and the date of the last meeting should be discussed and agreed well in advance. before termination could occur the group should evaluate the progress, plan for continued work, emotional reactions to termination can be handled, members can plan on special events or social gathering. the worker must be efficient in handling "good bye" issues which should not over take the positive aspects of the group. the worker should recognize and emphasize on the member achievement and group goal achievement and skills they have learned and accomplished.
termination of an unsuccessful group - this is the group in which goals are largely unmet. this involves feelings of anger, frustration, scapegoating, blaming and apathy. terminating unsuccessful group is as important as terminating successful group. this gives more input about where the problem is if given proper evaluation and scrutiny. the worker must be prepared to handle chaos and criticisms and respond in a positive way also realistic way.
dropping out - this is a single member termination where the group still goes on. there could be variety of reasons behind drop out. the leader should learn the reason that will not only help the member but also the group or another member in the group. this issue has to be handled in a way where it should not affect other members or discourage them in investing in group. the leader should work on this issue and try to help the member to resolve issues and get back in. whenever a member drops out the leader should discuss or inform the positive contributions made by the member to the group. thank for positive contribution. also inform the group of the reason for leaving so there is less chance of rumor and gossip and misunderstanding.
transfer of a member - this involves a planned arrangement between group leader and the member for a variety of reasons. the member being transformed should clearly understand the reasons for transfer and its more helpful if they volunteer to explain themselves to the group. this gives chance for the group members to wish the person well and to gain a sense of closure.
Departure of the leader - this termination is most difficult from worker point of view and the groups point of view. emotional reactions can be intense and adequate time to work through them may not be available. members who feel vulnerable and depend on you may feel devastated. some may feel anger, some feel its because of what they did or said, some personalize. also the worker has to work through guilt. its better to help the members or encourage them to express feelings. the new leader should be introduced and the transition should be as smooth as possible
The intellectual, emotional and social development of individuals may be furthered through group activities. In contrast to Case work or Group therapy, Group work is not primarily therapeutic except in broader sense. Different groups have different objectives such as, socialization, information exchange, curbing, delinquency, recreation, changing socially unacceptable values and helping achieve better relations between cultural and racial groups.
Activities and focuses of group vary: arts and crafts, vocational. first aid or training oriented, educational etc
Social Group Work is a method of social work which helps individuals to enhance their social functioning through purposeful group experiences and to cope more effectively with their personal, group or community problems (Konapka -1963)
Group therapy is aimed at facilitating the social, behavioral and emotional adjustment of individuals through the group process. Participants in group therapy usually have emotional, international or behavioral difficulties. Group therapy has several advantages over one-one counseling, such as the operation of the helper therapy principle which maintains it is therapeutic for the helper to feel he/she has been helpful to others. in contrast to one-one counseling, group pressure is often more effective in changing individual's maladaptive behavior, and group therapy is a time saver as it enables the therapist to treat several people simultaneously. eg: group therapy might be focused on individuals who are severely depressed, having drinking problems or psychologically addicted to drugs, those having an eating disorder etc.
Types of Groups
Recreation Groups - objective is to provide activities for enjoyment and exercise- groups are leaderless- eg,YMCA,YWCA,spontaneous playground activities.
Recreation skill groups - objective is to improve a set of skills while providing enjoyment - this group has an adviser, coach or instructor- more of task oriented eg golf, arts and crafts club, swimming etc. groups are led by professionals with recreational training rather social work training.
Educational groups - focus is to help members acquire knowledge and learn more complex skills. the leader is generally a professional person with considerable training and expertise in subject area eg, child rearing practices,assertiveness training, effective parenting, training volunteers. these groups may resemble a class with considerable group interaction and discussion being encouraged
Task groups - formed to achieve specific set of task or objectives- a group established for specific purpose like a committee in an agency. this group is disbanded after the group has completed the task.
Problem solving/decision making groups - service providers and consumers use these kind of group. three issues are important in this type of groups: group vs individual decision making, group think, decision by consensus vs majority vote.
focus groups - closely related to task and prblem solving groups. these groups are formed for a variety of purposes. like representative group. the members have been selected specifically to represent different perspectives or point of view of community. someone who can bring diverse views to the table.
self help groups - these are voluntary small group structures for mutual aid, and accomplishment of a specific purpose. there are 5 kinds of self help groups: acc to katz and bender groups that focus on self fulfillment or personal growth like AA groups and weight watchers and grops that focus on social advocacy like Welfare rights organizations, groups that focus on creating alternative patterns of living like gay liberation, outcast haven or rock bottom groups like ex drug addict organizations where people seek refuge to maintain their health without getting into relase due to societal or other life pressures and have a safe living arrangement. groups of mixed types
8. socialization groups - focus is to develop or change attitudes and behaviors of group members to become more socially acceptable. developing social skills, increasing self confidence, or any other focus.
9. therapy groups- composed of members with severe emotional or personal problems. leadership in this group requires skill, perceptiveness, knowledge of human behavior and group dynamics, group counseling capacities to use the group to bring about behavioral or other therapeutic changes. similar to individual therapy the goal of the therapy in groups in generally to have members explore their problems in depth and develop one or more strategies for resolving them. the therapist uses one or more therapy approaches such as psychoanalysis, reality therapy, learning theory, TA, rational therapy, client centered therapy and psychodramam to help promoting change in attitudes and behaviors.
10. encounter groups - EG or sensitivity training groups refer to a group experience in which people relate to each other in a close interpersonal manner and self disclosure is required. the goal is to improve interpersonal awareness. Acc to Baker a sensitivity group is a training and consciousness raising group rather than one that meets to resolve psychological or mental disorders. the process in encounter groups are 3 stages. Unfreezing, change and refreezing.
Types of Therapeutic Groups
Categorized by Corey and Corey
T groups /Therapeutic groups include encounter, awareness, self help, consciousness raising, sensitivity training and personal growth groups.
Gazda recognizes 3 types of groups
Guidance - primarily for prevention of problems facing high risk population, this group focus on improvement of life skills and overall direction of members
Counseling- for secondary prevention or correction, these groups include encounter, sensitivity and organizational developmental groups
Psychotherapy- tertiary prevention groups with the purpose of reeducating, rehabilitating and generally bringing members to healthy function.
Concepts related to Problem solving and decision making groups
Leadership and Communication
Groups think
Group decision making
Task/ role of group leader
Group stages
Stages of group development according to Bruce tuckman in 1965 - Forming, norming, storming, performing
Some Group therapy videos :
these videos should make clear the text content covered above from practical point of view.
Substance abuse - maladaptive pattern of substance use in-spite of its adverse effects
Substance Dependence - Presence of both tolerance and withdrawal. craving, preoccupation with substance in terms of need to use it and ways to get it, spend more time in substance use (either getting the substance/using of sub, or in after effects), taking more amount than intended, reducing occupational and social activities, continually using substance despite knowing its effects
Substance intoxication - development of reversible substance specific syndrome as a result of recent ingestion of substance, must include maladaptive behviour pattern and changes in nervous system.
Substance withdrawal - A substance-‐specific maladaptive behavioral change with physiological and cognitive correlates, due to cessation or reduction of heavy or prolonged substance use.
tolerance - a need for greatly increased amounts of the substance to achieve intoxication/desired effect or markedly diminished effect with continued use of the same amount of substance.
Substance specific intoxication and withdrawal symptoms
1. Alcohol intoxication : inappropriate sexual or aggressive behavior, unsteady gait, slurred speech, stupor, coma, rhythmic eye movement, in-coordination, impaired attention and memory, emotional lability, impaired judgement.
Alcohol withdrawal - insomnia, agitation, anxiety, hand tremor, grand mal seizures, tachycardia, sweating, nausea, vomiting, transient illusions or hallucinations
Amphetamine/cocaine withdrawal - insomnia, dysphoric mood, vivid and unpleasant dreams, increased appetite, psycho-motor agitation or retardation.
3. Caffeine intoxication - dieresis, restlessness, nervousness, flushed face, excitement, insomnia, gastrointestinal disturbance, muscle twitches, rambbling flow of thought and speech, tachycardia, periods of inexhaustibility, psycho motor agitation
4. Cannabis intoxication - impaired motor incordination, tachycardia, dry mouth, increased appetite, euphoria, anxiety, sense of slowed time, impaired judgement, conjunctival injection
6. opioid intoxication - initial euphoria followed by apathy or dysphoria, pupillary constriction, drowsiness or coma, slurred speech impairment in attention and memory
Opioid withdrawal - dysphoric mood, nausea/vomitting, muscle aches, lacrination or rhinoria (runny eyes or nose),pupilary dilation, diarrhea, yawning, fever, insomnia
Screening
self administered instruments (clients filling data themselves)
CAGE
MAST Michigan alcoholism screening test
DAST Drug abuse screening test
AUDIT Alcohol use disorders identification test
SASSI Substance abuse subtle screening inventory
T-ACE - specifically for women
TWEAK - for women drinking during pregnancy
Addiction severity index
Stages of change in behavior for clients with chemical dependency
Precontemplation (they are not aware a problem exists)
contemplation (they develop an awareness of the problem and start thinking about making changes)
Preparation - (they intend to make changes soon)
Action (they successfully change their situation)
Maintenance (there is continued change to avoid relapse)
Treatment planning
one of the best guides for chemical dependancy treatment planning by ASAM II is as follows :
early intervention
opioid maintenance therapy (in case of physical dependency on opiates)
the level of treatment is decided by the following factors:
intoxication or withdrawal (need for detoxification or ambulatory services)
other biomedical conditions and complications
emotional and behavioral conditions and complications
treatment acceptance or resistance
relapse and continued use
the individuals recovery environment
Treatment proved to work in chemical dependency issues
AA groups 12 step facilitation process
motivational enhancement therapy (4) sessions
Cognitive behavioral therapy (12) sessions
pharmacotherapy used adjunct to psychotherapies (meethadone maintenance for opioid dependency, naltrexone for reducing craving in alcohol and opioids, )
Points to keep in mind :
Wernicke’s Encephalopathy: caused by thiamine deficiency often associated with alcoholism; symptoms include confusion, loss of muscle coordination (leg tremors) and vision changes (abnormal eye movements, double vision, eyelid drooping).
Korsakoff’s Syndrome: retrograde and anteretrograde amnesia and confabulation (attempts to compensate for memory loss by fabricating memories); hallucinations.
alcohol is a tranquilizer
crack is the street name for smokeable form of cocaine
ice is the street name for smokeable free base form of potent concentrated methamphtetamine
cannabis- is a substance derived from cannbis plant, smoked as marijuana
cocaine - is a naturally occuring substance produced by coca plant
cocaine is usually snorted or dissolved in water and injected
speedball is the name of the drug mixture of cocaine and heroin
MDMA - ecstasy
tuolene, benzene, acetone, tetrachlorethylyne are commonly misused inhalants
morphiine is an opioid, opioids are also smoked, injected and snorted
The Social Worker uses the process of communication to create a helping relationship and achieve the goals and objectives of social work intervention. The SWr uses communication to bring about change in the thought and behavior of others. Communication is the change agent. Since the problem between individuals and families and groups is that of communication, the social worker uses her/her communication for the problem solving method.
Where does the problem occur?? What are the possible issues in communication? give us highlight in the issue.
Communication is the most effective aspect for establishing an effective helping relationship. extensive research has been conducted on 3 dimensions of helping relationship.
1. accurate empathy - ability of the worker to perceive and communicate accurately and with sensitivity both the current feelings and experiences of another person and their meaning and significance.
2. non possessive warmth - a major barrier to communication is our tendency to judge others. this tendency is stronger when our feelings and emotions are stirred, when we judge we are looking at the situation from our point of view rather than the clients. the worker can improve his/her communication with clients by improving and maintaining a non judgmental and accepting attitude.
3. genuineness - best understood as absence of phoniness.
these 3 constitute the essential skills involving therapeutic relationship that is at the heart of the practice. Additional qualities include correctness ieability to communicate thoughts and ideas clearly and specifically, competence ie prifeciency in carrying out his or her professional role and necessary knowledge required and objectivity which is the ability to see different point of view.
According to Shulman there are 27 basic communication, relationship building and problem solving skills identified and conceptualized in the four phase helping process.
1. tuning in phase
2. beginning phase
3. work phase
4. ending phase
the 27 skills are
1. clarifying purpose - important to be simple and use non jargons and be clear to the point in the purpose of worker client meeting. because a clear statement of purpose serves to define expectations and gives proper direction to the intervention.
2. clarifying roles : communicate empathy and non judgmental attitude as well as being realistic
3. encouraging the client's feedback on the purpose - giving the client an opportunity to voice differences in expectation so that clarification can be achieved.
4. displaying belief in the potential of the work - this is an offer of hope to client from workers point. sometimes it helps the client gain confidence in the social worker for acknowledging the problem and being realistic as well as finding chance to work through it in a positive way
5. reaching for between session data - this is workers communication to keep the worker up to date on what the client wants to work on, like starting where the client is.
6. moving from general to specific - helping the client express the problem in a precise and focused manner
7. the skill of reaching inside the silences - efforts of worker to understand and explore the meaning of client's silence. silence is a powerful behavior and says a lot. A brief silence of the client is best responded with silence from the worker. but when the silence gets long its important for the worker to intervene and respond with clarification or change of topic.
the following skills demonstrate workers empathy
8. understanding the clients feelings - by verbal and non verbal cues and worker trying to communicate it back to client that he/she can identify with the clients thoughts and feelings
9. putting clients feelings into words - refers to workers articulation of what the client is feeling. when this is done by the client, the worker is encouraging the client in a gentle way to express themselves.
10, connecting feelings to work- however the previous skill had to be used with caution in helping in the overall goal of the treatment process.
the following skills express genuineness
11. displaying feelings openly - this refers to the honest expression of feelings by the worker, but in relation to clients problem.
12. sharing personal thoughts and feelings- this skill along with the former one has to be applied in accordance with self disclosure policy levels appropriate to each setting. this may not be same in a psychiatric institution and correctional setting.
13. the skill of supporting clients strength - is a motivating factor and workers expression of confidence in the clients ability to accomplish a goal or cope with the situation.
14. partializing clients concerns - refers to workers communication directed toward breaking down a bigger or insolvable problem into smaller more manageable components. this helps client to have confidence, focus on solution and try to work towards solution in more measurable way.
15. holding to focus - helping clients focus on specific task, specially important when the client tends to ramble or avoids to work on a particular aspect which might give additional data on clients perspective on the solution or situation.
others include : checking for artificial consensus, pointing out the illusion of work, both dealing with clients resistance to work towards a solution. supporting client in taboo areas ie being sensitive and non judgemental, identifying affective obstacles to work which is aimed at clients awareness of blockage in any improvement or progress in working towards the solution. dealing with the authority theme is about worker communication in inviting the client to express any concern or complaint in problem solving process. helping client with ones own communication, putting out ending - terminating in a way client can take the termination, sharing ending feelings, sharing ending feelings asking for a review of learning.
More on this can be referred from the book mentioned in references.
Non Verbal Communication
Non verbal communication is as important as verbal communication. Some aspects include eye contact which shows workers willingness to work with the client and powerful indicators or sensitivity and understanding. a lack of eye contact is often interpreted as lack of concern and glarring and starring is considered rude. the intensity and duration of eye contact is important to make client feel comfortable and not distracting.
tone of voice reveals feelings as well. facial expressions sends a wide range of messages to client. and it is n this expression the worker expresses one's non judgmental attitude and acceptance. arm and hand movements like crossed legs, arms folded across chest, body rigidity, clenched fist, sends cues to client whose response might be influenced by this.
body positioning also conveys various attitudes and intentions. its best to face the client at ninety degree angle. since it suggests openness. leaning sightly toward the client expresses interest and acceptance. its better for worker to examine client body movements and mirror it if client seems disturbed or uncomfortable. dress and appearance is another important factor in dealing with diverse clients.
the "I" message and "You" message is another important aspect to consider in communication. The "i" messages are specially useful in interpersonal confrontation and conflict because it allows the sender to communicate disappointment, anger, frustration while minimizing the chance of discussion turning into fruitless argument. developed by Gordon this helps people to send clear message.
References
Techniques and guideleines for Social Work Practice , Bradford W Sheafor,charles r horejsi, gloria
Psychotropic drugs work by modifying neuro transmission processes-the chemical and electrical communication systems between nerve cells. Humans are thought to have 50-100 neuro transmitters, but only a few such as dopamine, serotonin, acetylcholine, norepinephrine, gama amenobutyric acid and glutamate are known to have direct relevance to psychotropic medications. the drugs can be roughly classified into 5 categories :
1. antipsychotic medications
2. anti depressant medications
3. mood stabilizing drugs
4. anti anxiety medications
5. psychostimulants
Antipsychotic medications can further be classified into conventional antipsychotics which include chlorpromazine (trade name : thorazine) , haloperidol (haldol), fluphenazine (prolixin) which has higher potency and adverse effects on neuro transmitters. the drugs are considered to have greater impact on positive symptoms like hallucinations, agitation, bizarre behavior than negative symptoms like flat affect, withdrawal and poverty of thoughts. The new type of atypical antipsychotics do not cause adverse effects as the former ones. they block activity of both serotonin and dopamine while the former blocks only dopamine. atypical medications include clozapine (clozaril), risperidone(risperdal), olanzapine(zyprexa) and quetiapine (seroquel). they may have some therapeutic effect on some negative and positive symptoms.
Anti depressant medications are classified into three types, the MAO inhibitors, cyclics and serotonin specific drugs. these drugs must be taken continuously before expecting a positive change since they experience resistance from the site where action takes place. all these drugs also have anti anxiety effects. the notable antidepressant medication includes phenelzine (nardil) and tranylcypropine (parnate) which are not prescribed frequently due to strict diet observation to be followed to avoid adverse effects of drug. common cyclic anti depressant include imipramine (tofranil), amilriptyline (elavil), nortriptyline (pamelor), dexepin (sinequan). the newest anti depressants are the selective serotonin reuptake inhibitors such as fluoxetine (prozac) , citaprolam (celexa), paroxetine (paxil), vanlafaxine (effexor) and sertraline (zoloft). fluvoxamine (luvox) ios predominantly used to treat OCD.
Mood stabilizinf drugs
Lithium carbonate is the primary drug treatment for bipolar disorder. monitoring blood levels is essential in using this drug. lithium has a low therapeutic effect and adverse reactions such as muscle tremor and kidney damage can occur at blood levels slightly higher than the therapeutic levels.
certain antiseizure medication such as valporate (depakote) and carbamazepine (tegretol) also act as effective mood stabilizer.
Anti anxiety medication
benzodiazepines constitute the largest class of anti anxiety drugs. they achieve their therapeutic effect by working on the GABA neurotransmitter. they are quickly absorbed in the gastrointestinal tract and has addictive effects with continuous use. examples of benzodiazepines are chlordiazepoxide (librium), diazepam (valium), alprozolam (xanax),clonazepam (klonopin) and l;orazepam (ativan). Buspirone (buspar) is a widely used anti anxiety drug which takes several weeks to take effect.
Psychostimulants
Stimulants are used to treat ADHD. has higher abuse potential. therefore prescription by phone and writing of refills are not allowed. moderate dosage of the drug improves attention, concentration and improved cognitive functioning while higher dosage has common adverse effects such as agitation and insomnia. methylphenidate (ritalin) is the most widely used psychostimulant, pemoline (cylert) and amphetamine (adderall, desoxyn, dexedrine) is a lesser used medication which has very high potential for abuse.
