Monday, March 2, 2015

Family Therapy for Eating Disorders

■ How Eating Disorders Affect Families



o Eating disorders can consume the client in obsessive, negative thinking and behaviors, and consume the client’s relationships with family members.

o Clients demonstrate the following symptoms

  • ● They become depressed, isolated, and tired.
  • ● They avoid relationships because in order to avoid the pressure to eat.
  • ● They are physically depleted.


o For Family members

  • ● Seeing a family member starve or damage her or his body is stressful.
  • ● Parents, spouses, or others become intrusive in their efforts to get the person to eat or to stop purging.
  • ◆ The result may be that the see them as enemies trying to control them rather than help.


o The symptoms have become the individual’s way to avoid facing problems more directly or are an attempt to feel in control when the rest of life feels out of control.


■ Family Risk Factors for Disordered Eating

o Interactional patterns in families of eating disordered patients tend to constrain autonomy and the expression of intimacy

o Disruptions in attachment relations are characterized by destruction communication

  • ● Behavioral family therapy, which Eating disorders may develop if a person has no other way to speak or represent feelings.
  • ● Family dynamics, problematic communication patterns, losses, or stresses like abuse have contributed to negative feelings the person could not deal with directly



■ Family Based Behavioral Interventions for Eating Disorders

o Emphasizes parental control over eating and incorporates cognitive restructuring and problem-solving training, has also been tested in comparison to individual therapy for anorexic clients

o The model of behavioral family therapy was more effective than an individual approach because it focused on the building of ego strength and facilitated autonomy in terms of increasing body weight from pre to post treatment

o Treatments were equally effective in outcomes such as eating attitudes, body shape dissatisfaction, and depressive symptoms






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Monday, February 23, 2015

Family Therapy for Couples

■ Behavioral couples therapy has been the most researched.

  • o Attempts to reduce substance abuse directly and through restructuring the dysfunctional couple interactions that frequently help sustain it


■ Integrative Couples therapy addresses some of the limitations of behavioral couples therapy.

  • o Helps couples to make arguments less harmful by teaching partners accept their differences.
  • o Therapy based on the importance of how a couple fights, not whether they fight or not.


■ Insight Oriented couples therapy and emotionally focused couples therapy have also been subjected to clinical trail investigations and found to be superior to no treatment.

  • o Is a combination of behavioral therapy and helping couples understand power struggles, defense mechanisms, and other negative behaviors.


■ Emotionally focused couples therapy maintains that relationship difficulties stem from the disowning of feelings and attachment needs, creating negative Interactional cycles and ineffective communication patterns.

  • o It has shown greater efficacy than no-treatment await-list controls.
  • o Enables couples to identify and break free of their destructive emotional cycles such as when one person criticizes and the other withdraws.
  • o The therapy helps couples build trust in each other.


■ Evidence for the use of Strategic therapy techniques in the context of couples therapy found an integrated systemic therapy model was equally effective as emotionally focused couples therapy and more effective than await-list control in alleviating relationship distress and improving target complaints and conflict resolutions.





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Thursday, February 19, 2015

Non-standardized Assessment Tests


Genograms
*        First developed and popularized in clinical settings by Monica McGoldrick and Randy Gerson.
*        Developed principally within the context of Murray Bowen’s intergenerational family systems theory, genograms offer an efficient and effective process for explaining repetitive behaviors and patterns.
*        Essentially, genograms are graphic representations of an individual’s extended family that typically cross at least three generations.
*        Use of genograms implies a respect for intergenerational family experiences as historical antecedents to contemporary areas of strength and difficulty.
*        Most genograms include basic information about number of families, number of children in each family, birth order, and deaths. Some genograms include information on disorders running in the family such as alcoholism, depression, diseases, alliances, and living situations.
*        Genograms reflect an individual’s point of view. Although most members of a family agree on the basics of a family tree, there may be major differences when describing the relationships among family members.
*        Interpretation is influenced by the creator of the Genogram. There is no absolute “right” Genogram for one family. Different family members may have differing perspectives on the relationships in the family and may therefore construct genograms of the same family very differently.

Scaling Questions
*        Used primarily in Solution Focused Brief Therapy.
*        Used to track differences and progress in the client.
*        Helpful in prioritizing goals.
*        Ranges of a scale can be defined in each time a question is made.
*        Typically range from worst (zero) to the best (ten).
*        Client may rate same question repeatedly as therapy progresses.
*        Client may be asked to identify times when the client felt lower on the scale.
*        Establishing goals or generating solutions comes from having the client identify what a higher score will look like for them and what they need to get there.
*        Strength focused questions include “What have to done to get to this (higher) score?” “What has stopped you from slipping one point lower down the scale?"
*        Exception questions include “Have you ever been higher on the scale?” “What is different on the days when you are one point higher on the scale?” “How would tell you that it was a 'one point higher' day?"
*        Future focus questions include “Where on the scale would be good enough for you?” “What would a day at that point on the scale look like?"


Dimensions of Sexual Experience
*        Trance State
        o        Akin to sensate-focus activities.
        o        Introspective attention to one’s kinesthetic cues of arousal.
        o        Individual becomes absorbed in sex.

*        Role Enactment
        o        Playing out roles of sexual fantasies and/or scripts
        o        Successful role enactment is indicated by in-depth integration with role during sex.
        o        Minimal involvement is indicated by avoidance, disinterest, or “faking it”

*        Partner Engagement
        o        Profound personal meaning is found in the sexual involvement with the partner
        o        Ranges from appreciation to sense of mystical union.
        o        Characterized by a unique, loving bond.

Power Hierarchies- on being Needed and Wanted
*        Wanting to be wanted- the individual searches for a reflected sense of self
*        Not wanting to want- attempt to maintaining boundaries to protect the ego.
*        Wanting to be wanted and gratified by not wanting to reciprocate- the individual is insecure about being exploited or abandoned and develops a narcissistic demand to be unilaterally gratified.
*        Not wanting to be wanted- the individual avoids any reciprocity.

These power hierarchies develop in response to differentiation and object relations issues from childhood in family-of-origin. Marriage devises the opportunity to resolve family-of-origin issues and individual long term development/existential conflicts.






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Monday, February 16, 2015

Experiential Family Therapy (e.g. Carl Whitaker)



A) Assumptions
1. Based on a pragmatic stance with the belief that theory can hinder clinical work
2. Each family member has the right to be themselves
3. Based on the belief of the family being an integrated whole, not as a collection of discrete individuals
4. Familial togetherness and cohesion is associated with personal growth
5. Emphasis on the importance of involving extended family members in treatment (especially the expressive and lively spontaneity of children)
6. Basis of this bold and inventive approach to family therapy was the result of Whitaker’s spontaneous and creative thinking
7. Stresses the importance of genuineness
8. Techniques are secondary to the therapeutic relationship
9. Whitaker believed in this a theoretical approach based on the assumption that many times, theory is way for therapist to create distance from clients; it also helps to control the anxiety of therapists by allowing them to hide behind their “theory”.
10. Emotional expression is thought to be the medium of shared experience and the means to fulfillment (personal and family).
11. Whitaker suggested that self-fulfillment depended on family cohesiveness.

B) Why People Do What they Do? (What Motivates Them?)
1. To be authentic and able to freely express oneself
2. Being autonomous while also feeling they are a part of the family
3. To have intimacy
4. Self-actualization and self-determination

C) How Do People Get In Trouble?
1. Symptoms and interpersonal problems stem from the lack of emotional closeness and sharing among family members.
2. The needs of the family may be suppressing the rights of the individual.
3. Keeping family secrets can lead to the dysfunction of family members.
4. The family has infringed upon its individual members’ growth and freedom.
5. Personal choice has been comprised.
6. Families put on a fa├žade which restrains its members from being authentic.

D) How To Help People
Goals of Experiential Family Therapy
• The primary goal of experiential therapy is to reduce defensiveness and unlock deeper levels of experiencing by freeing the clients from their impulses.
• Goals for the family

  • o improved communication and reduced conflict
  • o growth, not stability: symptom reduction is secondary to greater freedom of choice
  • o increased personal integrity (congruence between inner experience and outer behavior)
  • o less dependence,
  • o expanded experiencing
  • o emphasis on the feeling side of human nature
  • o improved autonomy for each member
  • o improved agreement about roles
  • o merger of needs for individual growth and strengthening the family unit.

1. The therapist’s active and forceful personal involvement and is the greatest way to bring about changes in families with the goal of promoting flexibility among family members.
2. A goal of therapy is to help family members open up and more fully be themselves by freely expressing what they are thinking and feeling.
3. The therapist conducts a family therapy session with the intent of it being a growth experience for him/herself, thereby inspiring the family to do the same; therefore, the therapist helps family members focus on the here and now by the therapist “being with” the family.
4. Focus on expanding immediate personal experiences and increasing the family’s awareness by achieving a higher level of intimacy.
5. Unmask pretense, create new meaning, and liberate family members to be themselves.
6. Aim for authenticity as there is no right or wrong way to be.
7. Attempt to unmask and tap into family secrets.
8. Guide the family through three specific phases: engagement (the most powerful), involvement (dominant parent figure, adviser) & disentanglement (more personal, less involved).

E) What Techniques And Skills Are Used?
1. Whitaker pioneered the use of co-therapists as a way to maintain objectivity.
2. Incorporates highly provocative techniques/interventions intended to create turmoil, turn up the emotional temperature, and intensify what is going on here and now in the family while then coaching the family how to get out of the turmoil.
3. Believed in doing therapy with a “crowd” in the room.
4. The therapist is active and directive to help create an intensified affective encounter for family members which allows for the family’s own healing and self-actualizing processes to take hold.
5. Therapist takes a theoretical stance as a way to intensify what the family members are presently experiencing and encourage them to reach into their unconscious to understand what is really going on in the family.
6. Facilitation of individual autonomy and a sense of belonging in the family.
7. Encourage spontaneity, creativity, the ability to play, and the willingness to be “crazy”.
8. The therapist's role is more of a facilitator. Through the use of reflection, he/she exposes the process of family interaction while joining the family process as a genuine and non-defensive person.

F) What Are The Limitations On Those Skills Or Techniques?
1. A great limitation is that this approach de-emphasizes theory and the use of “one-size, fits all” techniques.
2. Therapy follows a subjective focus and centers around the subjective needs of the family members (leaving room for bias or skewed perceptions).
3. This approach relies on a highly involved therapist model where the therapist must be visible, take risks, and get involved with family in the sessions.
4. Since success depends on the collaboration of several people, drop-out rates are high.

G) What Are The Professional Implications?
1. Whitaker typically relied on his own personality and wisdom, rather than any fixed therapeutic techniques to stir things up in families, so it is a hard theory to “teach” in terms of technique.
2. Whitaker believed in a confrontative approach which may not work well with fragile families.
3. This method incorporates an intuitive form of therapy which lower-functioning families/family members may not grasp.
4. He also acquired the reputation as the most disrespectful among family theorists since he often attacked or sought to overthrow traditional or popular ideas in family theory.
5. Some families may not appreciate the unrestrictive, intuitive, non-interventionist, and sometimes outrageous nature of this approach.
6. Rather than focusing on alleviating symptoms, this approach focuses on enhancing the quality of life of the family members. Although some focus on changing the family system may develop, it is not the primary goal. Therefore, this method may not be well suited for families who are looking for crisis management.





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Monday, February 9, 2015

Administrative Functions of Supervision


Administrative Functions of Supervision



The Administrative function of supervision seeks to ensure the social worker completes tasks associated with agency policy and procedure, and provides a senior mentor as a resource. Agencies must promote and maintain high work standards, a cohesive marriage between practice and policy within the administration, and offer the assurance of efficiency during an era of shrinking dollars, growing accountability and the need to maintain high ethical standards.

Two key reasons for supervision in social work today are licensure and regulation. This raises the bar on the relationship between supervisor and practitioner, placing the onus on the supervisor (legally, professionally and ethically) to be both accountable and responsible for their actions and the activities surrounding supervision of those in their charge.

Administrative supervision is also the mechanism within the bureaucratic structure responsible for the recruitment and selection of staff. This mechanism goes beyond simple resume selection and "check the box" qualifications for hiring. Astute administrative supervisors select personal characteristics, maturity, traits and attitudes that will foster the employee to feel comfortable in accepting and implementing organizational goals and objectives.

Administrative supervisors have both short- and long-term functional goals with employment hiring. Examples of short-term goals are issues like providing information on travel reimbursement, agency operations, training requirements, organizational structure, supervisory structure and relationship between departments. Long-range planning functions include activities such as setting up a departmental budget based on estimated future workloads and required resources to meet the estimated fiscal, personal and technical needs.

Often supervisors play all three primary supervisory roles, educational, administrative and supportive. For example, the department supervisor may provide staff development and support through a variety of team building activities, educational supervision through weekly supervisory conferences and do the primary hiring, work flow management and departmental budgeting.
Case:
Joyce works for a women's organization that provides job readiness skills, employment classes, literacy programs and short-term counseling. Her funding base is diverse, with individual donors, corporations, United Way funds, government grants and some state money. The department directors of each program report to her. She requires each department head to report out specific statistics and reports, each of which she reviews and plugs into organizational reports for formal audits and reporting to the board of directors, the public and in accordance with requirements for each funding source. She also asks each one to look one and two years out, providing educated estimates of the needs each believes their department will have to assist her in creating an organizational budget to take to the board of directors.

When the director of the employment program left for maternity leave, the organization was left short-staffed with few options for coverage. Joyce filled in some of the department head duties, in addition to covering a class and providing support to the staff that were facing increasing numbers do to the downturn in the economy.

The example demonstrates how a person whose supervisory role is primarily supervisory, also functions in other supervisory capacities, as well as the important nature of administrative supervision.





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