INTERVENTIONS

SW 420

The Social Work Process

Assessment Planning Action Termination

Evaluation

Steps of the middle phase (review): Assessment (examples: social history,

eco-map) Planning (example: change plan

worksheet) Goal-setting (sample contract) Intervention/Action steps to reach goals Ongoing evaluation (of your relationship

with the client, your understanding of the problem, your actions and interventions)

Intervention/action steps: some basics

Always tie interventions to goals and goals to interventions! Explain what you are doing and why you are doing it.

Methods to help clients reach their goals: Focus on the exceptions Shift focus using language (“when things

are better, what will you be doing?”) Increase awareness through mindfulness Build hope.

Basic action/intervention skills to use in session

Help REFRAME client experiences NORMALIZE common experiences EXTERNALIZE the problem (name it, take

away the blame, normalize, make it something outside of the individual)

Be aware of content and process. SHARE your observations of process and don’t get lost in content.

More basic skills

ROLE playing EDUCATION in and out of session Establishing boundaries in session You cannot be everything to every client

– REFER and LINK When using CONFRONTATION, allow your

client to save face. EXPECT change and look for it.

Working with clients on out-of-session action steps

Role play and visualization can help Anticipate problems with completing the

action step and elicit solutions Review the action step

If completed: reflect how the client said completing it made him or her feel

If partially completed: restate what the client accomplished and the barriers to completion. Re-evaluate, and modify goal if necessary.

If not completed: Reflect client’s report. Explore obstacles, motivation, and options.

In-session action step: Focusing

Redirect energy to relevant topics Direct attention to something significant

client said or did Avoid going off-task

“Would you please hold that thought so we can come back to it later? Let’s complete our plans first.”

“You said earlier that you especially want to work on _______. Let’s go back to that.”

In-session action step: Educating

Provide factual information about a topic (like development, diet, mental illness)

Teach specific skills (relaxation techniques, assertiveness, scheduling)

Use examples, stories, analogies, or metaphors to illustrate a point.

In-session action step: Advising

Recommend relevant readings, support groups, activities.

“I have a suggestion that I’d like you to consider. I recommend that you ______. What do you think of that?”

In-session action step: Using the here-and-now

Tapping into the client’s experiences and feelings as they occur during the session, including reactions to you, your relationship, or your work together. (Same as sharing observations of process).

“Right here and now with me you seem to be thinking/feeling/experiencing _______. Tell me more about that.”

“Right now as I’m talking, I notice that your eyes are turned away from me. You seem to be looking off into the distance and thinking of something else. What are you experiencing right now?”

In-session action step: Reframing

Propose to clients a new way of looking at some aspect of themselves, the issue, or the situation.

“When you say that you’re “stupid” and “indecisive” because you have difficulty choosing between various courses of action, I feel confused. What you refer to as indecision seems to me to be the ability to see different points of view. It sounds like you’re open-minded and willing to consider many perspectives and options. What do you think of that?”

In-session action step:Normalizing

Point out ways the client is unfairly labeling himself or herself as “crazy,” “sick,” “a freak,” or “weird”.

“You say you’re crazy because you’re anxious and depressed after losing your job. Wouldn’t even the most well-adjusted person feel out of sorts and have trouble sleeping after being laid off from a good job and not having any immediate prospects?”

“Sometimes what seems like craziness is really a normal reaction to a crazy situation.”

In-session action step:Confronting

Point out to clients – directly and without disapproval – discrepancies, inconsistencies, or contradictions in their words, feelings, and actions.

“On the one hand you say you enjoy coming to these sessions and benefit from them, but on the other hand you have missed two of our last appointments. What do you make of that?”

Action step: Giving homework Behavioral activation – schedule tasks or

activities Monitoring automatic thoughts – client

asks herself, “what’s going through my mind right now?” when a distressing mood occurs, then writes down these thoughts along with a coping thought to counter the negative thought.

Suggested readings Individualized homework specific to

session content

Action step: Giving homework (2) Sample homework tasks:

Write a list of five goals List your most common negative thoughts and

possible alternative explanations Keep a log of activities throughout the day to

see how you are spending time Walk 15 minutes 3 days a week Do something frightening to see that the

results are not catastrophic (e.g., “This week I will approach a new person in class and will ask a question about the readings.”

Action/evaluation step:Evaluating progress

Remember to expect success and actively look for it.

Goal attainment scales (…would you say you were very successful, mostly successful, mostly unsuccessful, or completely unsuccessful?)

Frequency counts (…how often did you do X this week?)

Subjective ratings (…how do you feel today?)

“On a scale of 1 to 10, with 1 being the worst possible and 10 the best, how is your mood today?”

Action/evaluation step: Eliciting feedback

Especially at the end of the session, it can be helpful to directly ask the client questions about important points, disappointments, etc. in the session

“What did we cover today that’s important for you to remember?”

“Was there anything that bothered you about the session today? What was it?”

“What do you want to make sure we cover at the next session?”

The intervention or action step depends on:

What the client hopes to achieve What approaches are appropriate for the

client (age, culture, family circumstances…)

Whether the action is ethical Whether you have the skill set to

implement the action plan What your theoretical approach is

Let’s start with theory

Story handout

Some theories/approaches

The task-centered system Crisis intervention Cognitive restructuring Solution-focused brief treatment Case management

Task-centered approach: beliefs People are capable of solving their own

problems Work on problems identified by the

client, not the social worker Client sets the priorities Collaborative relationship is key

Task-centered approach

Time-limited (6-8 sessions, usually) Termination begins the first session Problem-solving

Interpersonal conflicts Difficulties in relationships or role

performance Reactive emotional distress Inadequate resources Organizational roadblocks

Task-centered approach

Target problem Develop/negotiate goals Develop general tasks Develop specific tasks Monitor progress

TIS: Task Implementation Sequence

Enhance the client’s motivation to carry out the tasks

Plan the details of carrying out the tasks Analyze and resolve obstacles Rehearse or practice behaviors involved

in the task Summarize the task plan

Basic interventions used in the Task-Centered approach

Externalize

Role Play

Refer and Link

Homework

Education

Expect success

Cognitive Restructuring

Intervention techniques are designed to help people change their Beliefs (“I am a selfish person,” or “No one

will ever love me.”) Faulty thought patterns (“He would love me

if I lost ten pounds”). Destructive verbalizations (“Sorry, my fault,

I am so stupid.”) The idea is: CHANGE YOUR THOUGHTS

CHANGE YOUR BEHAVIOR

Central tenets of cognitive approaches

Your thoughts determine your behavior Especially your inner dialogue Important to separate thinking from feeling

Cognitive processes influence your behavior Cognitive processes include: attention,

retention, production, motivation A change in behavior can be

accomplished by changing the way people think.

What are some common cognitive distortions?

All or nothing thinking Blaming Catastrophizing Discounting positives Emotional reasoning (how I feel is who I am) Jumping to conclusions Over-generalizations Unfair comparisons What-ifs

Steps in cognitive restructuring Assist clients in accepting that their self-

statements determine their emotional reactions to events

Assist clients in identifying dysfunctional beliefs and thought patterns (tool: self-monitoring)

Assist clients in identifying situations involving dysfunctional cognitions

Help clients REPLACE negative self-statements with positive ones

Assist clients in finding rewards and incentives for successful coping

Simple interventions used in cognitive approaches

Reframing

Normalizing

Externalizing

Confrontation

Homework

Expect success

Client Scenario 1

A middle school student is struggling with peers at school – he is not very popular, gets teased a lot by classmates and has started skipping school because of the problems. He has been referred to the school social worker by the teachers once his grades started to drop, he is reluctant to talk to someone because he thinks that people will make fun of him even more if they find out.

- List some of the possible actions/interventions that might be appropriate for this client.

- Decide for each action whether it is direct practice (micro) or macro practice.

Client Scenario 2A middle aged woman has been told that her

sister is terminally ill with cancer and is not expected to live more than 3 months. She is distraught and upset, she also lost her mother in a car accident almost 1 year ago. She is meeting with you - the hospital social worker - after being referred by her sister’s doctors.

- List some of the possible actions/interventions that might be appropriate for this client.

- Decide for each action whether it is direct practice (micro) or macro practice.

Client Scenario 3A young woman has come to the community

mental health center to meet with a social worker about domestic violence issues. She was physically abused by her ex-husband and even though he is no longer involved with her, she is concerned about dating or marrying another abusive man. She wants to learn how to be assertive and protect herself from physical and emotional harm but she doesn’t know where to start.

- List some of the possible actions/interventions that might be appropriate for this client.

- Decide for each action whether it is direct practice (micro) or macro practice.

Final stuff

I know you are getting anxious about the final psychosocial assessment assignment – I am re-tooling it to align with our labs so that you can use your lab experience OR a field/work experience for the assignment

Cases are due this week and next week Next week: termination and evaluation,

followed by three weeks in the lab.