Theoretical Perspectives For Direct Social Work Practice - Essay Example

Theoretical Perspectives For Direct Social Work Practice Table of Contents Statement of Purpose . . . . . . . 2 Item 1: Reflection on Personal Practice: Implications for Clinical Practice Guidelines . . . . . 4 Item 2: An Evaluation of Cognitive Behavioral Therapy in Addictions Counseling . . . . . 7 Item 3: Nurturing Spirituality and the Humanistic Perspective in Addictions Counselling . . . . . 10 Item 4: Mind Map . . . . . . . 14 Item 5: Counseling Case from Journal Excerpts . . . . . . 15 Personal Portfolio Statement of Purpose Caught up in the everyday tasks, social work practitioners often do not make time for reflection and evaluation of one’s practice. The work of David Schon (1983) on reflective practice has ultimately been very influential in various fields including social work. Thompson (2008) argues that “ it is essential not only to create time to examine our work analytically, but also to do so critically – that is, by looking beneath the surface of the presenting problem (critical depth) and situation and more widely at the social circumstances in which practice is taking place (critical breadth)” (p. 1). This involves looking at presenting problems and cases with more depth by examining the influences, and locating the issues within a greater socio-political context. Critical reflection of practice cannot happen overnight, and the skills need to be developed for it to become a productive habit among practitioners. Creating a personal portfolio is the first step in nurturing the reflective practice in my profession. This course has given me a wide breadth of theoretical knowledge, which I am able to translate back to my practice. However, to be able to create effective applications, I have to go through series of personal and professional reflection, evaluation and assessment. I consider this a lifelong endeavour as an addictions counselor. The field will always evolve, and the cases by virtue of individual differences are varied and dynamic. While this is challenging, the diversity and variation is an added wealth of experience, gradually developing my level of expertise in the field. I have always known that this is the profession I want to dedicate my life’s work. To quote my first interactions with a client, “…when I looked into that little girls eyes, and knew that I had made a connection, I knew that I had made her world a better place, that is when I knew for sure that I chose the right profession…” My professional goals include:  Continuous development of knowledge and skills in designing cost-effective treatment plans;  Updating of inter-disciplinary skills that will yield best outcomes for clients;  Contributing to the body of knowledge in addictions counseling through research in professional practice;  Active involvement in local and international professional groups to increase networking with professionals in the same field;  Develop leadership and managerial skills to take on a supervisory role. This portfolio hopefully outlines the steps I have taken to reach my professional goals. It also contains reflections of my practice which in future will guide the initiatives I will take to be able to move forward professionally. The first item contains an overview of my clinical practice, and how I understood it based on the practice guidelines which I have adopted as a counselor. The second and third items are perspectives that I have been using in counseling and intervention sessions. More specifically, it discusses the use of cognitive behaviour therapy, and taking the humanistic and spiritual approaches in interventions. The fourth item is a discussion of the mind map I use during group therapy sessions, with evaluations and reflections on its utility. The fifth item is a presentation of a specific case that I handled. It contains personal notes and reflection from me and the client. Item 1: Reflection on Personal Practice: Implications for Clinical Practice Guidelines The practice of social work has gone through various changes over time. Social work is a fast evolving discipline and now its challenge includes the creation of an “integrated approach grounded in the context of critical community practice, a greater emphasis on internationalism, the incorporation of a political dimension in practice and the preparation of social workers to serve as interpreters of environments for policy makers and the public, and an engagement with critical postmodern theories that envision social work as an emancipatory project” (Finn & Jacobson, 1999, n.p.). Social work as a discipline has been called to produce evidence-based practice that is borne out of concerted efforts to best serve the interests of the clients. Clinical practice in social work is increasingly becoming an area of interest among researchers. With the influx of various disciplines, such as psychology and sociology, creating a clear framework for practitioners is necessary. Moreover, the significance for practice guidelines becomes heightened with the move to create effective social work practice. “Unlike recent efforts to promote empirical practice that required clinicians to conduct research, clinical guidelines support scientifically based decision making in a manner that reduces clinical uncertainty and otherwise assists social workers in their day-to-day activities” (Howard, 1999, p. 284). Although challenging in terms of implications on skills and competencies, the guidelines have proven most effective in creating positive outcomes among the clients. In 1998, SAMHSA published the ACC as a Technical Assistance Publication (U.S. Department of Health and Human Services [DHHS], 1998). The ACC is divided into two sections. The first contains the Transdisciplinary Foundations organized in four dimensions, which cover the basic knowledge and attitudes for all disciplines working in the addiction field. The first dimension requires practitioners to gain a comprehensive awareness of the current models and theories of addictions emphasizing the need to understand the behavioural, psychological, physical and social effects of psychoactive substances. The second involves knowledge of treatment which extends from the onset of seeking treatment until after re-integration into the society. A counselor recognizes the interplay of different treatment models in seeking the intervention that will best suit the client. Third, involves the transfer of theoretical knowledge to practice. Application requires proper diagnosis and assessment to design effective treatment plans. Indeed it is the data gathering stage about the applicant that yields significant information leading towards effective counseling and intervention. The fourth dimension is professional readiness which can only be achieved through extensive and intensive experience in the field. Personally, I have found the value of clinical supervision and continuing education in professional growth. In addition, as a counselor, it is also imperative for me to provide ways and means to enrich myself personally, and maintain sufficient quality of life. The second section of ACC is composed of eight dimensions focusing on the professional practice of addiction counseling. The first dimension involves clinical evaluation which comprises of evaluation and assessment. I have realized that evaluation and assessment can sometimes become habitual and I as a counselor can fall prey to routine evaluation and assessment. I find consulting with colleagues and supervisor(s) as an effective process to gain a fresh perspective on cases that I handle especially at the initial stages. The treatment planning is the second dimension which throughout my professional years has gained rapid changes. Currently, I have taken a client-centered approach which actively involves the client in the planning stage. The third dimension is closely related to treatment planning, counseling. In almost all cases, counseling is extended towards family and significant persons in the client’s life. Fourth dimension is service coordination which involved case management, client advocacy and implementation of the treatment plan. Fifth, which involves much of treatment process, is the referral process where counselors facilitate the client’s use of support systems and community resources. As a social work practitioner, it is also our responsibility to educate families and communities about the effects of psychoactive substances. This sixth dimension involves information dissemination across various units in the society. Seventh is proper documentation of the treatment plan and the client’s progress. I find record keeping instrumental not only for monitoring purposes, but also to generate data that can possibly contribute to evidence-based practice. The last dimension constitutes the professional and ethical responsibilities of the counselor. It includes responsibilities to adhere to accepted ethical standards and professional code of conduct and for continuing professional development; knowing and adhering to all federal and state confidentiality regulations; abiding by the Code of Ethics for addiction counselors; and obtaining clinical supervision and developing methods for personal wellness. The importance of clinical practice guidelines, such as that created by SAMHSA (1998), cannot be neglected by social workers in the clinical practice. As there are several approaches that a counselor may prefer, the guidelines ensure that counselors become continuously aware of their responsibilities for delivery of most effective treatment programs. These guidelines are also practical in their application and serve as basis for daily tasks of practitioners. However, there remains a need to update the guidelines and further improve research data on what works, and for what types of cases or populations. Item 2: An Evaluation of Cognitive Behavioral Therapy in Addictions Counseling Cognitive-behavioral therapy (CBT) stands out as the most studied and widely applied in treatment programs. “The therapy is based on the findings that thoughts as well as people and situations cause the feelings and behaviors associated with relapse, and in turn, it is possible with therapy to change thoughts about and reactions to relapse-provoking situations” (McLellan, 2008, p. 99). “Rather than focusing on the client’s problems, CBT emphasizes the client’s strengths to help clients become their own therapist” (Ronen & Freeman, 2007, p. xxiii). This principle finds good application in the field of clinical social work, the goals of which include helping individuals, groups and families to lead happier lives, achieve self-fulfilment, and become productive citizens. In my practice, I achieve this through clinical evaluation and continuous assessment. Social work is moving towards an evidence based practice, and assessment is an important tool for measuring the success of the intervention. Borrowed largely from the clinical practice of psychiatrists and psychologists, CBT provides an appropriate framework that allows for evidence-based practice. Through CBT, I am able to monitor my patients’ progress and eventually extend the intervention to include couples and families. Proper documentation and clinical reports have made me more confident of the conclusions and recommendations I make with regard to the patient. It has also allowed me to make a more systematic approach on recording and analysis. The objectivity with how assessment and monitoring is approached guarantees minimal biases in interpretation and a valid picture of the patient and how the different life aspects interplay into the substance abuse. The goals of social work have been defined broadly as “to assist individuals and groups to identify and resolve or minimize problems arising out of disequilibrium between themselves and their environment” (Ronen & Freeman, 2007, p. 3). Thus, it becomes important for social workers to “look for patterns and order behind societal changes, human functioning and human experiences, and they must try to make sense of people and situations in which they find themselves” (Ronen & Freeman, 2007, p. 4). I have found that the way to achieve this is by mediating the socio-cultural experiences of my patients and the way their cognition perceive these experiences. If I can find a way to help them direct their thoughts, then I can slowly facilitate changes in behaviour. External and internal triggers have been identified as highly correlated with substance abuse and relapse. If a person feels that s/he has no choice but to use addiction to achieve a desired behaviour or emotion, then that feeds his/her addiction. In my practice, I often employ coping skills training. I usually start off with a “functional analysis,” a form of assessment where I determine the antecedents of the person’s drug/alcohol use and abuse. I use structured interviews and other batteries of test to assess the history and dependence of the patient. For each antecedent that is identified, I ask the client what s/he expects to gain out of the drug/ alcohol use. Most of the needs expressed are logical, the problem is how the needs are addressed. My role is to help the client find better alternatives to achieve their needs. For patients to overcome the deficit in using effective coping skills, I introduce them to skills training. Practice of skills is given both in session and as homework. I explain to the clients clearly the need for these practices so they become “fluent” in the skills and access them readily when faced with a threatening situation. I would give clear discussions of the desired skills identified based on the assessment. These skills can be broadly classified into two --- intrapersonal and interpersonal skills. Intrapersonal skills involve managing the thoughts and cravings for the substance or alcohol. I usually practice this by giving them high risk situations and negative thoughts, and discussing with them how to avoid these. Anger management is also part of intrapersonal skills. I usually model the skills like using calm down phrases, and considering other options other than anger which the clients later on act out. Furthermore, I discuss, practice, and develop pleasant activities, relaxation skills, decision-making skills, problem-solving skills and emergency plans with the patients. All these are constructive and proactive measures to combat further drug use and intake of alcohol. Interpersonal skills are those that involve other significant person/s in the client’s life. I work with the clients in practicing skills for refusing the drink or the drug, and the requests from other people. I also work with them in handling criticisms which often feeds the anger and drives the client to risky situations. Furthermore, I found it important to discuss and work on the client’s intimate relationships, especially since this is one of the factors that may reinforce avoidance of substance/ alcohol. There are also other social skills that I practice with the clients such as building better social networks, and confidence and assertiveness in social interactions. In addition, coping skills training are also done with the clients’ significant others. In most cases, social relationships and the environment are the factors that affect the patient’s success in therapy. The real test of what takes place in my counselling session comes when they are reintroduced into the community. Clinical social work is committed to empowering the individual by equipping him/her with skills to counter the causes of his/her problems or oppressions. This is an aspect that CBT is able to develop as it gives the client an opportunity to take an expert stance about his/her situation. As a counselor, my role is to rally on the client, and provide him/her with the support s/he needs to make proactive steps in improving his/her life. In the process, I affirm the client’s strengths and his/her inner capability to rise above the addiction, despite the circumstances that surround him/her. This step is especially essential in helping the client regain control over him/herself. Item 3: Nurturing Spirituality and the Humanistic Perspective in Addictions Counselling “When I approach a new patient, I don’t think of him or her as an addict, I think of that person as an individual—a son, daughter, mother, or brother—with something to give to society. I try to picture them before their problem and to help them to remember why they are here, what they are trying to achieve.” (Excerpt from Journal, 12 December 2009). Whenever I encounter a client, I have come to realize that each one is an individual searching for order and meaning. Throughout my career, I have arrived at a realization that each life that each life begins as a blank sheet, and the substance of our actions fills it. I perceive each patient as a person as an individual—a son, daughter, mother, or brother—with something to give to society. This is I believe at the core of the humanistic approach to clinical social work. The humanistic approach to social work perceives an optimistic view of the individual, “a view of people as having an inherent drive toward growth, health and self-actualization” (Coady & Lehman, 2008, p. 54). In my practice, most substance abuse and alcoholic patients referred have reached the state of “rock bottom.” They are most likely depressed and have failed to recognize hope in their lives. They also more often than not arrive with a pervading resistance against the clinical work. This is what I consider as a major challenge as I try to reconcile within myself the resistance and defensive attitude of the client. The humanistic perspective allows me to treat each client as a potential despite the grim situations that they are in. I do my best to try to communicate this to them, and within the course of the therapy they slowly open up to the possibility that they can be better than where they currently are. By nurturing the humanistic attitude towards my clients, I help them transcend the initial struggle within themselves to change, and take that first step towards wellness. As previously mentioned, during counselling sessions, I maintain an equal stance with my clients. I make sure that they understand that the treatment plan is a collaborative product of him/her and me. This way, they establish a sense of ownership for their success; something which they can bring with them as they face other challenges in life. The existentialist perspective is one of the cornerstones of this approach I have employed. In psychotherapy, existentialism is “identified by their orientation toward desirable goals than by particular well-defined technical or procedural guidelines” (Coady & Lehman, 2008, p. 322). I achieve this by constantly dialoguing with my patients, and actively listening to what they are stating. I pay attention to how the patient articulates the direction of his/her life. I ask questions that draw out how s/he perceives the meaning of life. These are very important areas to take note of and high light to help the client in goal setting. Acculturation and deeply ingrained thoughts are significant aspects that may contribute to the client’s addiction. When I speak with the clients, I make sure to keep notes of perspectives and ideas that may be a result of the kind of home, school or environment that he grew up with. The existential theory holds that there are possible assumptions that a client may hold about himself, and his relationship to the world that may have caused him to develop in these problematic cycles. I am able to draw out these essential assumptions and ideas by adopting the existential perspective. More of than not, acculturated ideas are products of the client’s spirituality, and this is an issue that is becoming important for counselors to deal with properly. Spirituality, if used properly, can be an effective tool for delivering patients for addiction and alcoholism. This has been proven by the effectiveness of the Twelve Step Facilitation Therapy which boasts of its spirituality component. The twelve-step facilitation therapy (TSF) based on the 12 steps and 12 traditions of Alcoholics Anonymous have gained wide recognition in addiction treatments. McLellan’s (2008) review of the different studies examining TSF supports the “effectiveness of this therapy versus personal care” (p. 100). An interesting quality of this approach is the promotion of spirituality to attain recovery. The TSF though usually done in groups, but can also be administered at an individual level. A number of my clients have articulated the significance of spirituality and religion in their lives. I have witnessed rehabilitated substance abusers who became pastors and charismatic group leaders. They expressed that they have found meaning in their beliefs and belongingness in the community that they serve. These are not surprising statements as many addiction clients have had history of parental abandonment in childhood. They seek a sense of family and community, which they ultimately find in religious organizations. I have also encountered a number of clients who grew up in an environment with substance abusers. A significant amount of their life encounters were spent with them, making them dependent on these kinds of individuals. Finding better peers who are not associated with substance abuse and have direction in their lives will prove most helpful for past substance abusers. They become detached from their peers who had detrimental influences, and start over with more encouraging and positive groups of friends. I have come to realize that to become a competent addictions counselor, I must continuously update my skills in cognitive-behavioral therapy. I accomplish this through more clinical supervision and professional development. CBT is the sufficient tool that brings the patient to wellness using an emancipator perspective. It treats the patient as an individual with the capacity for healing and taking control of his/her lives. This way, I empower the individual and make him slowly less dependent of the counseling sessions. Furthermore, resonating with the values of emancipation and empowerment, the humanistic and existential perspectives I incorporate into the strategies facilitate the client’s regaining of self-esteem and self-control. Upon reflection, I have realized that only through a genuine and sincere interaction with the patients, will I be able to equip them with the confidence and trust in themselves to create better lives. In addition, to become a “culturally competent” counselor, I must seek to understand and appreciate how spirituality plays a role in their healing process. In fact, spirituality can be a strong force in total rehabilitation. All these three perspectives help to ensure that I adhere by the professional standard of ethics, and treat my clients with utmost respect and honesty. As a counselor, I myself must also seek toward wellness of being. It is this subtle type of modelling that helps clients reach their goals. These theories in social clinical practice were created as a guide for social workers and counselors. The success of the interventions greatly depends on the ability of the counselor to help the patient create changes for him/ herself. I have realized the importance of continuously developing myself, professionally and personally, to be able to effectively facilitate the healing process of my patients. Item 4: Mind Map Presented below is the “Say No To Alcohol” Mind Map which I often employ during group counseling sessions. I usually organize the group by starting out with a goal setting session where they are to fill in the branches in the mind map. In cognitive behavioural therapy, goal setting is very essential, and goals must be articulated well by the clients themselves. I start off with this session to engage the group and help them see that everyone has future goals that are within reach, and maybe even identify some of their own. Support systems are usually created during group counselling. The process helps the clients witness for themselves that there are others like them who are struggling with alcoholism or addiction. The use of the mind map further gives them hope in what they are trying to resist and achieve in the future. In fact, this idea of hope was reiterated by one of my patients who used the internet as a good opportunity for networking with those in the same circumstances. In his online journal, Tony Doe writes: “I am not going to put my name on this website, but I am going to put an email. I check it regularly. If you have gone through something similar you can email me and I will write back. I want you to know that there IS HOPE.” Not all clients are able to embrace group counselling sessions, and I have employed a method of using online sessions for clients to interact with each other, where they may feel a higher degree of safe environment. This is one innovation that technology has provided recently. If counselors manage to think out-of-the-box, there is a wide range of support systems that can be offered to the clients. Considering the successful outcomes of support groups, systems of networking cannot be neglected in treatment plans. Item 5: Counseling Case from Journal Excerpts “…there were things I don’t think I could have ever talked about before—not to even to my husband. I couldn’t even tell my counselor. But when I wrote them down, it was like someone else talking. It all just came out…” (Betty Doe, 04 July 2005). Relevant Background Information The client currently works as a nursing aid in a home for the elderly. She reports feeling out of control at work, and feels that superiors and coworkers are singling her out. She reports that she generally likes working with geriatric patients. She dislikes authority figures and her own lack of authority. Client is currently residing with her boyfriend. She states that her boyfriend and his clients/friends drink around her regularly and keep alcohol in open areas in the home, making it difficult not to drink herself after release from Alcohol Rehabilitation Facility XYZ. Statement of Concern Client wants to feel empowered over alcohol. She states that she doesn’t want to drink, but that other people make her drink. She says when she is intoxicated she feels scared. She wants help fighting relapse into her addition. The Power of Writing Writing is a form of expression, and many times the first hurdle my patients face is fear of just that. After years of submitting to abuse, giving in to their depression, or trying to hide an addition themselves, they have learned to avoid their real feelings. They have learned to compartmentalize the things that cause them pain, as if hiding those things from the rest of the world somehow makes them less real. One of the first steps I like to take is breaking through those boundaries—cutting through the self-doubt and lies—and giving the patient the freedom to express themselves without fear of reprisal. Not only is the expression healthy, this therapy also builds trust. I have found writing as instrumental as well for me as a therapist. Looking back at journals that I have written, I become more aware of my own personal biases that may confound how I deal with clients. Furthermore, studying what I have written help me generate more ideas for interventions that I can discuss with the client in succeeding sessions. Reflective writing is not only a matter of writing down observations, but it also includes detailing my own personal subjective experiences and judgments. This is helpful for me to correct myself and find significant areas which I may have missed in-sessions. References Coady, N. & Lehman, P. (2008). Theoretical perspectives for direct social work practice. New York, NY: Springer Publishing Company, LLC. Finn, J.L. & Jacobson, M. (2003). Just practice steps toward social work paradigm. Journal of Social Work Education. Retrieved from http://www.accessmylibrary.com Howard, M.O & Jensen, J.M. (1999). Clinical practice guidelines: Should Social Work develop them? Research on Social Work Practice, 9, 283-303. McLellan, A. T. (2008). Evolution in addiction treatment concepts and methods. In M. Galanter & H.D. Kleber, The American Psychiatric publishing textbook of substance abuse treatment. Arlington, VA: American Psychiatric Publishing, Inc. Ronen, T. & Freeman, A. (eds). Cognitive behaviour therapy in clinical social work practice. New York, NY: Springer Publishing Company, LLC. Thompson, N. (2008). Paper presented at the La Qualita del Welfare Conference at Lake Garda, Italy. Retrieved from http://www.avenueconsulting.co.uk/neil-thompson/documents/BecomingaCriticallyReflectivePractitioner.pdf Read More