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Showing posts with label biopsychosocial. Show all posts
Showing posts with label biopsychosocial. Show all posts

Saturday, April 20, 2013

Therapy concepts in practice - viewing a client using many perspectives from psychology


about the client, Angela:

The client is 17 yo, unmarried but w/same BF Tony since she was 14yo, Caucasian

currently pregnant with her 2nd child

Tony is less than supportive of her and the child's well-being - blames her for getting pregnant

Lives w/mother and two younger brothers, 14yo and 16yo. Living condition described as "not very good." Plumbing is rusty, pipes often get clogged. Frequent roof leaks after a day of rain. Landlord seems "careless"about the conditions of the house.

Mother's BF often stays at the house. Been through much drug/ETOH tx, however using cocaine "occasionally," he says. 1x made aggressive sexual advance at Angela when high on coke. told mother, did not believe her. No recurrence. Relationship between Angela and mother strained since. Feels "misunderstood and devalued."

Dropped out of school 2 yrs ago, after 1st child born.

unemployed

Been receiving federal assistance: WIC, food stamps, and cash assistance. Recently rec'd letter from Dept Soc Services that she is required to look for employment and/or go to job training to continue getting fin aid. Difficult to find job due to: childcare, current pregnancy, lacking transportation, lacking immediate family support.

Ct feeling optimistic that condition will change eventually. Several friends and extended family provide emotional support, but unable to help otherwise b/c they find themselves in similar conditions.

Ct already has goal to move out of mother's house, though worries about being able to support herself & children.

Axis III:
pregnant, 2nd child

dx diabetes, special balanced diet advised by MD, to avoid pregnancy complications
Difficulty attending prenatal care appts - lack of transportation. Feels physician does not understand her situation - tells her to be "more responsible and less neglectful." Physician "treats me like a child" ignoring "my suggestions and comments." Often gives her forms she doesn't know how to fill out.


1. What are major differences and/or commonalities between Constructivist / Social Constructionist Theory and Freudian’s Psychoanalytic Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).

Psychoanalytic: Human behavior can be explained, predicted, dx, maladaptive behavior originating with defective dev/brain
Constructivism: no universal truth, but behavior can be explained.

Similarities:

development is important
individual internalization of experiences influences development
relationships are important in development
in tx, learning about self (psyc: bring unconscious conscious, and understand and moderate unconscious drives; const: client learns how their self has been constructed, and recreates it)

Differences:

Psyc: relationship to family/parents is focus; Const: rel at micro, meso, macro levels
Psyc: predetermined developmental stages and tasks, human behavior can be diagnosed, predicted and understood. Cause and effect is important. Practitioner is the expert. Client tends to be unaware of how thoughts influence behaviors.
Const: self constructed, deconstructed, and reconstructed throughout the lifetime. no universal assumptions about human behavior. People need not be confined to a "box" of existence. Language and communication give power. Client is the expert.
Const: focus on experience/repetition creating schemas, structure is constantly updated
Psych: Id & superego battle it out, mediated by ego. each at different level of consciousness.

2. What have been the dominant critiques of Psychodynamic Perspectives in social work and how has the perspective developed in light of these critiques?


3. What are major differences and/or commonalities between a Freudian’s Psychoanalytic Theory and Feminist Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).

Similarities:

differences between genders (some flavors of feminism)
encouragement of clients to share their personal thoughts freely (free association and dream interpretation vs. personal narrative)

Differences:

no stages in feminism
feminism holds that gender differences are not morally important because every gender is capable of reason
feminism is non deterministic, while psyc is deterministic
psyc - femininity as a frustration about wanting to be masculine, not something valuable in and of itself
psyc focuses on childhood experiences, while feminism focuses on the present environment and changing it

4. What are major differences and/or commonalities between Freudian’s Psychoanalytic Theory and Erikson’s Bio-Psychosocial Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).





5. Considering the assumptions and principles of the diverse theoretical orientations discussed in class, what would an eclectic approach look like?



Defining eclectic social work:
An eclectic approach is one which draws from many theories, including complementary, competing or even contradictory theories, depending upon the situation and client need.
Eclecticism can be used for both explaining human behavior and intervening in human behavior.
Clients benefit from eclectic interventions and explanations because they are less likely to feel placed into a steadfast category.
The eclectic social worker seeks to match the most helpful theoretical explanation or intervention to the client/community/population.

6. What are some of the implications of engaging in social work practice, with minimum to no understanding of different theoretical orientations, within the context of human development in diverse settings, encountering diverse strengths and challenges?

lacking in terms, language used to conceptualize client issues and strengths and communicate with client, help them understand.
theory helps organize and guide SW practice (though not define it)
theories give framework and rationale for treatment
theories can often compete, overlap, contradict, which gives social workers a rich base from which to understand different situations and client systems

lacking in theoretical understanding may result in a social worker lacking in insight, issues w/solving client's problems, may lead to superficiality or only surface social work.
may struggle with effective communication.
too much time wasted with "hit or miss" approach. missing out on experience of learning from the mistakes of others.
knowledge of theory increases knowledge of self, hopefully decreasing the harmful effects of transference and countertransference.

7. What are major differences and/or commonalities between Cognitive-Behavioral Theory and Freudian’s Psychoanalytic Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).

Similarities:

exploration of the past (though this is more central to psyc)
assumption that behavioral change can come through cognitive change (though more central to cbt)
assumption that people can have control over their thoughts, emotions, and behaviors

differences:

CB therapy practice is shorter typically, and uses operant and classical conditioning vs psychoanalysis which typically lasts years
CBT is more substantiated in research
CBT is more task oriented, and the therapist plays a central role giving feedback, teaching skills. Psyc - patient does free association and dream interpretation.
psyc - human nature seen in pessimistic, cbt focuses on ability for self-knowledge and change
cbt is less complex in practice
sex not important to cbt unless they affect problematic thoughts or behaviors, while it is integral to psyc

8. What are major differences and/or commonalities between Constructivist / Social Constructionist Theory and Erikson’s Bio-Psychosocial Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).




9. What are major differences and/or commonalities between Carl Rogers’ Person-Centered Approach and Freudian’s Psychoanalytic Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).

Similarities:

Rogers: importance on uniqueness, potential and inner drive; Freud: motivation comes from Id and Superego, biologically driven
Rogers: everything client says has meaning to them; Freud: everything a person does or says has meaning, and through dream interpretation, free association, it can be found

Differences:

Rogers: self-actualization, optimism; Freud: pathology based
Rogers: self-understanding leads to natural motivation to improve and self-actualize; with Freud, motivation focuses more on overcoming an obstacle (negative vs. positive orientation)
Rogers: lifetime development/self-actualizing; Freud: childhood/adolescent development
Rogers: practitioner and client are in a partnership; Freud: medical model of practitioner expertise
Rogers: client driven; Freud: client driven in content, practitioner driven in process
Rogers: no stages as behavior is reflective of client's internal world; Freud: psychosocial stages rooted in biology

10. What are major differences and/or commonalities between Feminist Theory and Erikson’s Bio-Psychosocial Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).


Feminism challenges that Erikson's BPS theory, about development as disconnection, independence and separation do not generalize to females, and in fact are opposite. feminism sees development as connectedness and caring. Erikson implies cross-culturality of his theory, and gender neutral.

Feminism believes that dysfunctional behavior is that which privileged groups believe it is, specifically that it is about behavior of less privileged groups, and not really "dysfunctional" but has been functional.

Some flavors of feminism believe that women are naturally more nurturing, and men more aggressive. Erikson appears to be gender neutral.

Feminism believes that knowledge is holistic, not linear as in Erikson's stages.

Feminist theory - "personal is political" concept that the political environment influences development - similiar to Erikson, except he includes the


Similarities:

focus on person in environment, interactions between person and environment lead to development
Liberal feminists believe in biological similarity between women and men. Erikson sees a biological component to development

differences in practice - Erikson would look to complete specific developmental tasks. feminism - develop empowerment

Feminism would look to increase social support, empower through optimism and understanding the importance and individuality of her experience. Additionally - learn to "work" the system, use resources which are available, build social capital, with confidence that she and her family deserve the help, and it's the society's failure to protect the vulnerable when there are significant social service shortfalls. Feminism would not see Angela in a predetermined linear developmental model.

11. What are major differences and/or commonalities between Cognitive-Behavioral Theory and Erikson’s Bio-Psychosocial Theory? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).


BPS: bio, psyc and social factors all play significant roles in human functioning
CBT: as I think, so I feel, and do; 1. Activating event; 2. Beliefs about the event or evaluation, either rational or not rational; 3. Consequences in the form of feelings and behavior; interplay of thinking and feeling produces behavior (similar to antecedent, behavior, consequent of behavioral theory)

Similarities:
both involve thoughts, emotions and behaviors

differences:
CBT focuses more on the individual's structure of thinking/schemas, including beliefs, attitudes, assigning of meaning, which is inherent in BPS. BPS also includes social and other environmental and biological forces which strongly influence development. In CBT, individual interpretation is heavily focused upon. In BPS, more holistic focus, and focus on 8 stages of development and meeting developmental tasks. A fully developed person

12. What are specific distinctions between Liberal, Radical, Socialism/Marxist, Black, and Postmodern Feminist Orientations? (Compare and Contrast)


helping understand how one is oppressed, and the practitioner empowers them

liberal feminism - wanting equality for men and women; no differences between sexes
focus on the denial of equal access to society's resources for girls and women. capacity for reason is equal. sex differences have been translated by cultural interpretations into gender roles
criticized for ignoring differences and preferences between men and women, interests and experiences

radical feminism - differences between the sexes; wants a cultural revolution against the patriarch
women have been made subservient and forced to be in specific roles in the family and society which are designed to meet male needs
values differences between men and women

socialism - focus on intersection of class and gender through the economics of capitalism and patriarchal social structures that maintain female subordinance;
stress has been placed on women b/c of the economic structure of the society and the family
criticized for not considering psychological consequences of oppression, such as depression

black feminism - emerged due to lack of feminist perspective on racial/ethnic/cultural differences between women and men. assumption: class, culture, color result in different types of oppressive experiences; also reaction to liberal feminism which did not give much appreciation to females who chose to be mothers/enjoyed parts of the traditional female role

postmodern - recognizes the multiple voices of women, deconstructs the traditional theories and opposes generalized propositions about 'what it is' or 'what it isn't' like to be female; a constructivism specifically applied to gender issues and women's rights. criticized because it's strong emphasis on diversity makes it difficult to gain solidarity for taking action

feminism - patriarchy is in charge, women are at mercy of the patriarchy; only solution is to becomes empowered individually and collectively to push change

practice:

knowledge and values are interrelated; your knowledge of the inequalities will also reflect on your values; you have to begin to wake people up; focus on the person's narritive; all of Angela's problems are partially due to patriarchy holding her down - job, stuck w/the kids alone
and she stays because she has been oppressed into believing that others hold the power

13. What are major differences and/or commonalities between Feminist Theory and Carl Rogers’ Person-Centered Approach? (Consider assumptions & principles of each of these theoretical orientations when responding to this question. Also, consider discussing this comparison and contrasting of theoretical orientations within at least two different contexts - situations).


feminist theory general assumptions:

Social structures, especially within the United States, privilege / give advantages to men and oppress women.
Knowledge and values are interdependent.
There are many ways of knowing – Knowledge is holistic not linear.
The personal is political.
Inequality affects gender relationships
Differences among the sexes should not promote a sense of female inferiority.
In order for egalitarian relationships to be promoted changes must occur at the individual and social level.

feminist theory principles:

goal: egalitarian society / relationships, women not marginalized
consciousness-raising promotes change. exposure to the dehumanization.
encouragement to take social action to change social conditions
use of an empowerment perspective / strengths

rogers basic concepts:

Individual experiences are subjective to their perceptions. (similar)
individuals react according the their perceived reality
behavior is used to satisfy needs
concept of self influences behavior (similar, and with feminism the society / political climate are emphasized in the creation of self)
incongruence occurs when there is a split between ideal and actual self (can be seen in feminism - dehumanization of women and their experiences is not congruence)
client is the expert (similar)
rapport, trust, collaboration vital (collaboration is key in feminism, as well as trusting oneself)

more similarities:

use of unconditional positive regard in tx, and non-directive style, fit well with feminism's focus on embracing and understanding individual humanness
focus on here and now, trusting self

14. If a Masculine Perspective was developed, adopting the logic of a feminist perspective, what would it look like?




Saturday, November 6, 2010

Psychodiagnostic basics: DSM IV TR categories

  • Psychological Disorders – a harmful dysfunction in which behavior is judged to be atypical, disturbing, maladaptive and unjustifiable
  • DSM-IV – a widely used system for classifying psychological disorders; defines 17 major categories of ‘mental disorder,’ describes disorder and lists prevalence; no explanation of causes
  • Medical Perspective – psychological disorders or mental illnesses (psychopathology) can be diagnosed based on symptoms and then therapy is sought to cure the illness; these disorders are understood to be physical in nature and can be diagnosed, treated and cured
  • Bio-psycho-social perspective – how biological, psychological, and social factors interact to produce psychological disorders; mind and body are inseparable;
  • Anxiety disorders – psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety; involve both feeling and cognition where there is an appraisal of one’s social skill and anxiety
    • Generalized anxiety – one is continually tense, apprehensive, and autonomic nervous system is in a constant state of arousal
    • Phobias – persistent, irrational fear and avoidance of a specific object, activity, situation; irrational fears that disrupt behavior
    • Panic disorder – short-term episode of intense fear where one experiences terror and physiological sensation because something terrible is going to happen to them
    • OCD – unwanted repetitive thoughts, obsessions and/or actions
    • Learning perspective – researchers have looked at the relationship btwn anxiety and classical condition of fear; as we grow older we become conditioned to fear many things
    • Biological perspective – using natural selection researchers have argued that humans are predisposed to fear threats faced by ancestors
  • Mood disorders – psychological disorders characterized by emotional extremes; psychologists are trying to develop a theory
    • Major depressive disorder – prolonged hopelessness and lethargy until normality; longer than two weeks
    • Bipolar disorder – one alternates btwn depression and manic
      • Mania – one is characteristically overly talkative, overactive, elated, lack of sleep, loud speech, overly optimistic, high self esteem; affects about 1% of population, men and women equally
    • Biological Perspective – hereditary, women twice as vulnerable
    • Social cognitive perspective – focusing in particular on control beliefs such as self defeating beliefs which may arise from learned helplessness, making bad experiences really worse
    • Schizophrenia – disorganized or delusional thinking, disturbed perceptions and inappropriate emotions or actions – most debilitating of mood disorders
      • Disorganized thinking – fragmented and distorted ways of thinking that may result from a breakdown in selective attention
      • Delusions – false beliefs that may accompany psychotic disorders
      • Disturbed perceptions – sees things that are not there; hearing voices to seeing, feeling and smelling things that are not actually there
      • Subtypes
        • Paranoid – preoccupation with delusions or hallucinations with themes of persecution or grandiosity
        • Disorganized – disorganized speech or behavior or flat/inappropriate emotion
        • Catatonic – immobility or excessive purposeless movement, extreme negativism and/or parrot like repeating of another’s speech of movements
        • Undifferentiated – many unvaried symptoms
        • Residual – withdrawal after hallucinations and delusions have disappeared