Clinical Social Work 1 - Midterm

Essential components of social worker-client relationship

(1) Attention to basic need. (2)Response to aggressive impulses. (3) Lessening of punitive self-criticism.

Interpersonal Process

Way in which the client and therapist interact with one another, rather than the content of what they are talking about. Shapes how the client will be able to change.

Process Comments

Present focused, immediacy interventions that invite clients to explore or sort through with the therapist what is transpiring between them right now. "you & me, in the here & now"

Relationship between theory and practice

Theory: how we plan to interact with cleint's based on studies and research. Practice: how we actually interact with clients during treatment.

Ruptures

Misunderstandings, mistakes, interpersonal conflicts which disturb the therapeutic relationship.

Meta-Communication

Talk together directly and discuss therapist-client communication dynamics in the moment. To talk about how we are talking to each other.

Sullivan founded..

(1) Focus on actual experience between child and caregiver. (2) Identify client's anxiety and how they respond to it, what they do to minimize it.

The Interpersonal Domain

(Sullivan) Behavior and relationships with others. Real life interactions with caregiver.

Conceptualized Personality

The collection of interpersonal strategies that the individual employs to avoid or minimize anxiety, ward off disapproval and maintain self-esteem.

"Self-system"

Children develop this through repetitive interactions with their parents.

Coping Styles

Interpersonal defenses originally necessary to protect self from caregiver.

Central Tenet of Object Relations Theory

Concerned with attachment or with the individual's inherent need to bond and be close to others. Interaction between infant and caregiver.

Internal Working Models

Mental representation of close interpersonal relationships, especially those between parents and young children, and how these are templates for what is usually going to transpire between self and others shape current functioning.

Three Types of Insecure Attachment

(1) avoidant. (2) ambivalent. (3) disorganized.

Mirroring

(Kohut, pole 1) Ideal that the individual needs to reflect and identify with others and the world around them. Grandiose self can be satisfied. Social worker should meet clients need rather than interpret it. Allows client to feel more understood and can establish a certain level of trust within the therapeutic relationship.

Idealizing

(Kohut, pole 2) Need to have someone strong, calm and wonderful to idealize and merge with in order to feel safe and complete with self. Clinician must present themselves as a good, powerful, important, trusting and strong; client wil lthen feel safe and trust the relationship.

Twinship Transference

(Kohut, pole 3) The need to feel that there are others in the world who are similar to oneself. Develop security & a sense of belonging. Enhance nuclear self. Client will feel as likeness, a sameness with the therapist.

Why do children internalize bad objects?

(Fainbairn) Bad objects are internalized and then repressed. Child will protect abusive parent. If child's object present as bad to him then he himself will feel bad and the child would rather see himself as bad than his objects as bad. Becoming bad makes the child's objects good. Child will internalize the bad object to survive, would rather have a bad object than no object.

Splitting

If caregivers are more severely unresponsive or abusive, some children resort to "splitting defenses"; child internalized he "bad" aspects of the parent in a sharply separate or split-off way from the "good" aspects of the parent. Makes caregiver seem "good" and then the child feels "bad".

Projective Identification

Primitive defense mechanism in which the individual projects an unwanted thought or feeling onto another and identifies the projected material as belonging to that other.

Klein describes Projective Identification

Person experiences relief by projecting the offending feeling state onto another and discharging his or her aggression towards the other.

Bion describes Projective Identification

Can function as a means of expressing a need; infant cries to be breastfed. Infants angry cry projects the feelings associated with mother being away.

Resistance

A natural component of therapy. Most clients have positive and negative feelings toward therapy. Coping strategy.

Resistance is often driven by..

shame, culture, family, guilt and the struggle to change.

Signs of Resistance (8)

(1) missing appointments or being late. (2) limited hours of availabilty. (3) frequesntly rescheudling. (4) client doens't want to make firm committment. (5) remains vague. (6) reluctant to talk freely. (7) avoids certain topics. (8) abruptly suggests stopping and terminating sessions before change occurs.

Countertransference

The therapist's personal reactions to the client based on the therapist's own life history and unresolved issues on current personal stressors.

Client-Induced Countertransference

The therapist's reaction to the client that occurs when the client's eliciting maneveurs or coping styles typically evoke similar reactions in the therapist and others.

Therapist-Induced Countertransference

Occurs when the therapist's own personal history or problems have been activated by something the client has said or done. This is the traditional conceptualization of countertransference. Clients will test therapist to see how they respond.

Transference

The systematic misperceptions or cognitive distortions towards the therapist (and others) that are based on the clients internal working models or schemas.

Empathy

A genuine feeling of warmth, concern, and acceptance of others. This is accompanied by an accurate, specific, and in-depth understanding of client's problems within a developmental, familial and cultural contextualization - which enables therapists to make sense of clients seemingly irrational responses.

During Empathy the therapist...

(1) discerns clients thoughts & feelings. (2) effectively communicates his or her understanding of this to the client.

Containment

The safety, support, and validation that therapists offer clients so they can experience their emotions more fully in the moment without fear of judegment or criticism.

Holding Environment

A safe haven of empathetic understanding and attuned responsiveness that therapists provide to help modulate or contain the client's distress or disruptive feelings. (Starting point of treatment)

Validation

An affirming approval or sanction by a secondary person. This has an especially significant impact when an important experience has been denied or minimized by significant others.

Invalidation

To dismiss, weaken, or engender uncertainty in another's personal or subjective experience.

Corrective Emotional Experience (CEE)

A reparative, real life experience with the therapist that resolves rather than seemingly repeats a familiar but maladaptive relational pattern.

Collaborative

Where the therapist and client work together as partners rather than the therapist directing or leading the client from a position of "expert" and prescribing solutions or providing the client with ourselves.

Working Alliance & 3 Distinct Components

The therapeutic relationship has been conceptualized as being comprised of 3 distinct components: (1) working alliance, (2) real relationship, (3) transference-countertransference dimension. Consists of the bond between therapist and client, agreement on treatment goals and consensus on the tasks or interventions that will be sued to facilitate change.

According to Horney, the 4 questions a therapist should ask to identify core conflicts:

(1) What are the clinet's unment developemntal needs? (3) What is the original envrionmental issues precipitating the problem? (3) What are the cleint's intrapsychic defenses against the conflict? (4) What is the client interpersonal strategy to overcome core conflict?

Moving Toward

A fixed and pervasive interpersonal strategy for coping by repeatedly trying to please others, exercising excessive compliance and avoiding identity and autonomy. (more caring)

Moving Away

A fixed and pervasive interpersonal strategy for coping and adapting via distancing from other through physical avoidance, emotional withdrawal, or rigid self-sufficiency. (not needing others)

Moving Against

A fixed and pervasive interpersonal strategy for coping with others by asserting dominance or aggression as a characteristic way of relating to others. (strong leaders)

Confrontation

Client may view therapist as hostile or accusatory. New therapists sometimes avoid using process comments as they feel they may be confrontational.

Dealing with Core Conflicts

The most basic or central issue that links the different problems and concerns that clients present, which, in turn provides a focus for treatment.

Core Conflicts are Repeated in 4 Ways:

(1) Interaction with therapist. (2) Way he or she handles crises/very stressful events. (3) Developmental relationships with fmaily members. (4) Current relationships with friends and significant others.

Working Through

A stage of therapy when the client's trying out new ways of responding to others. In this phase clients are experiencing successes & disappointments with different people in their lives and the therapist is serving as a coach or an ally as the client repeadtedly tries to change old patterns with new and better ways of responding.

Termination

ending of services/therapeutic relationship. Approximately 30% of clients drop out after completing only an intake sessions.

Positive Termination

Helpful in the client's ability to trust possible future relationships can be nurturing and stable.

3 distinct components of the therapeutic relationship

(1) working alliance, (2) real relationship, (3) transference-countertransference dimension.