Monday, November 24, 2014

Divorce

The diagnosis typically assigned for clients and families dealing with divorce is depression. The symptoms are usually the same for children, adolescents, and adults.

Symptoms:
•        Persistent sadness
•        Inability to enjoy favorite activities
•        Increased irritability
•        Physical problems such as headaches and stomach aches
•        Poor school performance
•        Poor work performance
•        Persistent boredom
•        Low energy
•        Poor concentration
•        Changes in eating and or sleeping patterns

Long-term Treatment Goals for Treating Depression due to Divorce
•        Improved mood and stability
•        Prevent further episodes of depression
•        Help the client become well established in a new family living arrangement

Short Term Objectives
•        Develop therapeutic rapport
•        Identify feelings and anxieties about divorce
•        Increase social contacts and create a support system
•        Develop coping skills to deal with depressive thoughts and feelings
•        Discuss the feelings about the loss of the family relationship is it was
•        Help client adapt to new situation

Interventions
•        Verbal therapy to discuss feelings
•        Play/ Art therapy:
        o        Pairing emotions and colors
        o        Draw different representations of emotions symbolically
        o        Use clay or other materials to recreate story
        o        Puppets to tell a story
        o        Board games designed to discuss feelings
•        Writing:
        o        List positive and negative emotions or changes
        o        Journal feelings
        o        Unsent letters
•        Parent Education
        o        Teach parents about typical emotional reactions they will see in their children and how to handle them.
        o        Encourage parents to make teachers aware of the situation.
        o        Have parents engage in an activity with the children each week, teach dyadic techniques.


Infertility- inability to conceive during one year of sexual intercourse without the use of contraception, or the inability to carry a pregnancy to live birth.

There are two kinds of infertility diagnoses:
•        Primary infertility - couples who have never had a child
•        Secondary infertility - couples who are unable to conceive or to achieve a live birth after having previous children.

Male infertility
•        Lifestyle habits can markedly affect the quality of the semen.
        o        Alcohol can damage sperm-producing tissue.
        o        Tobacco decreases sperm survival and function.
        o        Diet and vitamins have been researched to affect sperm production.
        o        Sexual practices can be altered to increase fertility.
•        Abstinence periods of three to four days produce larger semen quantities and greater viability.
•        Certain common lubricants such as KY jelly, lotions, and oils can kill sperm and decrease fertility.

Female Infertility
•        Can often lead to profound distress for women and may affect sexual functioning in couple’s relationship and is associated with a wide range of factors:
        o        Physical- hormonal, anatomical, genetic, immune system
        o        Psychological- denial, grief, helplessness, anger, anxiety, and guilt
        o        Environmental- work related stress, family issues, gender role expectations.

Goals of Therapy
•        Explore their beliefs about creating a family
•        Identify and explore feelings and reactions to infertility
•        Create a support system
•        Provide educational materials related to medical procedures
•        Assist partners in communication about sexual relationship




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Assessment Methods and Techniques

Assessment Methods and Techniques

The purpose of a specific assessment must be clear. Assessment is not to be done for assessment’s sake or beyond the disclosed purposes in informed consent. Social workers are bound by the NASW Code of Ethics (section 1.07 (a)) to respect client privacy, which means a social worker should never seek information out of curiosity or just because. The purpose of the specific assessment will drive the information sought. For example, if the assessment is court ordered to determine safety of a home, pending the return of children removed due to abuse or neglect issues, assessment will focus on safety, parenting, stress factors, coping skills, drugs and alcohol, attendance or completion of court ordered treatment and extended family supports. Great importance may be put on verifying information with secondary sources (records of attending treatment, drug tests, speaking with family). In another example, if the assessment is voluntary with an adult seeking treatment for depression, the assessment may include standardized depression inventory (i.e. Beck Depression Inventory) in addition to the clinical interview, with less requirement for external sources to verify the information given.

Many forms of recording assessment information are possible. One may use evidenced-based, user-led, form-led, standardized assessments or non-standardized assessment tools. Regardless of the type used, accountability is important. Evidenced-based practice is important because it allows the client and social worker to track change, and most payers, whether private insurance, publicly funded agencies, not-for-profit agencies, military medicine or other funding, a demonstration of progress is required for reimbursement. Evidenced-based techniques can be used with a variety of theoretical orientations; the issue is measuring behavior, mood or attitude and its subsequent changes.

Assessment done with an evidenced-based approach will expedite the setting of goals and treatment planning.

The assessment process should engage the client in the therapeutic process, creating a working therapeutic alliance on which to base treatment. The client has to feel comfortable enough to share the issues surrounding their presenting complaint and the issues that may have bearing on treatment planning, though they may not be the focus on treatment. The best way to engage the client is through rapport building throughout the assessment process.

It is important to listen actively, attending to both what is and is not said, as well as the client’s body language. Responding with full attention, reflecting what is being said and the deeper understanding of the client’s situation based on the client’s report, clinician observations and information gathered during assessment will assist in the rapport building process. Making culturally sensitive introductions and using the client’s preferred name during the session will also aid at putting the client at ease.

During the assessment session, it is important to check in with the client, either directly or indirectly, and to provide validation or normalize feelings, as appropriate. This technique allows the clinician to clarify the information and emotion shared, while also letting the client know he or she is being understood. If inconsistencies are present, addressing them can also be helpful but should be done with respect.

Assessing the clients communication patterns, as in neurolinguistic programming, can also be a useful tool in increasing rapport, individualizing the communication response, assessing the individuals subjective experience and empowering the individuals requisite skills to work together in the therapeutic alliance.





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Monday, November 17, 2014

DSM and ICD Health Problems

Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases & Related Health Problems (ICD)



Diagnostic and Statistical Manual of Mental Disorders (DSM)
o Handbook for mental health professionals.
o Includes all categories of mental disorders and their corresponding diagnosable criteria.
o Intended to be used by those with clinical training.
o In accordance with the American Psychiatric Association.
o Uniform criteria for diagnosing.
o Includes sociological, psychological, biological, criteria.
o Each revision has discarded some previously diagnosable disorders such as pre-menstrual dysphoric disorder and masochistic personality disorder to show the manual is contemporary with social times.
o It now no longer includes homosexuality as a mental disorder, replacing it with sexual orientation disturbance, though still controversial.


Diagnosing Categories
o Axis I: Clinical disorders, including major mental disorders, as well as developmental and learning disorders
o Axis II: Underlying pervasive or personality conditions, as well as mental retardation
o Axis III: Acute medical conditions and Physical disorders.
o Axis IV: Psychosocial and environmental factors contributing to the disorder
o Axis V: Global Assessment of Functioning GAF score
o A scale from 100 (good functioning) to 0 (several dysfunction)


International Statistical Classification of Diseases and Related Health Problems
o Abbreviation ICD.
o Classification system for diseases including a directory of symptoms complaints, and external causes of injury or illness.
o Published by the World Health Organization.
o Used by hospitals and healthcare facilities to best describe clinical assessment of a client.




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Monday, November 10, 2014

Gestalt Therapy

Gestalt Therapy



Techniques

■ The experiment in Gestalt therapy

  • o To assist clients self awareness of what they are doing and how they are doing it
  • o Expanding awareness of client
  • o Opportunity to “Try on” new behavior
  • o Experiments bring struggles to life, inviting client to enact them in the present
  • o Major emphasis on preparing clients for experiments though trusting relationship


Confrontation

  • o Imposing stance

● Therapist meets own agenda for the client
● Acts as expert, power and control in therapist

  • o Competing stance

● Therapist promotes rugged individualism with lots of negotiation compromise and confidence

  • o Confirming stance

● Acknowledging the whole being of client
● Client’s needs and experience center of relationship
● Ideal type of confrontation
● Invites client to look at incongruities in verbal and nonverbal language, in words
versus action.

■ Internal Dialogue o Identifies the struggle for control in a person, fragmented between controller and controlled, through Introjection of aspects of others

  • o Between top dog and underdog
  • o Between critical parent should and oughts and passive recipient without responsibility and with excuses
  • o Empty chair

● Shift client into two chairs for dialogue role lay.
● Experiences conflict

■ Reversal technique

  • o Role play the opposite of symptoms and behaviors client suffers
  • o Client tries the very thing fraught with anxiety, therefore submerged and denied
  • o Help clients to accept personal attributes that they have tried to deny


■ Rehearsal exercise

  •  o Behavioral rehearsal: role play a planned for new behavior with a person or people in client’s environment.
  • o Reduce stage fright, anxiety or fear
  • o Encourages spontaneity and willingness to experiment with new behaviors


■ Exaggeration Technique

  •  o Exaggerate movement or gesture repeatedly to intensify feelings attached by behavior to make inner meaning clear
  • o Trembling hands or feet, slouched posture, bent shoulders, clenched fists, tight frowning etc.


■ Staying with Feelings

  • o Keep client from escaping fearful stimuli and avoiding unpleasant feelings
  • o Encourage to go deeper into feeling or behavior they wish to avoid
  • o Facing, confronting, and experiencing feeling makes them able to unblock and make way for new levels of growth

● Takes courage and pain.





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Tuesday, November 4, 2014

Social History Collateral Data

Social History and Collateral Data

A social history is an individual or family assessment that includes information, both past and present, needed for developing an understanding of and working with clients. The appropriate use for collateral information is to augment the patient’s history. Collateral reports (e.g. family reports, hospital discharge summary, school reports, and arrest record) can be useful in verifying client data or augmenting the information given in the verbal report(s). Collateral reports are particularly useful when substances or mental illness impairs a client or no collateral sources of information are available because in such cases, the availability of information is a primary challenge. A social history will vary from setting to setting, depending on the needs of the provider or providers and the specific client population. However, there are some stable categories all should share. A social history will include information about the presenting problem, social role functioning, family history, employment/educational history, physical health issues, alcohol or drug issues and mental health issues. If the identified client is a child, collateral data may be sought, with signed consent by the parent or legal guardian, from teachers or other caregivers. If the identified client is an adult, additional information may be desired and sought, with permission and signed consent by the client, from a physician, probation officer, other provider, family member, discharge summary, medical record or other applicable collateral source.

Depending on the situation, collateral data may be more or less required. If a client is seeking voluntary services, is highly motivated for treatment and his story is consistent with his presentation, collateral information may not be necessary. For example, Ben presents for help with his drinking. Ben wants to stop because he believes he is relying on it to cope with his problems rather than to deal with them. He attends all sessions as scheduled, completes all homework as assigned and the writings and step work he presents are consistent with dedicated recovery work.

However, if a client is seeking services to stop drinking following a third arrest for driving under the influence and is facing jail time if he is not compliant, collateral information may be indicated. Involuntary clients who may only be motivated by the avoidance of negative consequences have some motivation to be less than forthcoming. Additionally, when the legal system is involved, the social worker is at risk of having to produce records or possibly testify about a client. If this is the situation, the social worker is best advised to seek collateral data to verify the client’s story, both past and present. While the client may have “hit bottom” and be completely truthful and motivated following a bad event, too much is at stake to not verify information. When alcohol and other substances are involved, honesty is the first casualty. Encouraging clients to be honest may be the therapeutic thing to do, but when a significant probability of testimony is involved, the social worker must be self-protective and best protect the client and society at large by having all of the facts to make the best and most informed decision.





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