Tuesday, September 18, 2012

License Exam: Human Behavior in the Social Environment (18 %)

Human Behavior in the Social Environment (18 %)

Ecological Systems theory

Microsystem: Refers to the institutions and groups that most immediately and directly impact the child's development including: the individual.
The FAMILY exists between these two (Micro and Mezzo) systems, as it encompasses the individual and close relatives, which forms one unit.
Mezzosystem: Refers to relations beyond the individual client; generally, a group of people related to the individual. E.g., school, religious institutions, neighborhood, and peers.
Macrosystem: Describes the culture in which individuals live. Cultural contexts include developing and industrialized countries, socioeconomic status, poverty, and ethnicity. A child, his or her parent, his or her school, and his or her parent's workplace, and different levels of government are all part of a large cultural context. Members of a cultural group share a common identity, heritage, and values. The macrosystem evolves over time, because each successive generation may change the macrosystem, leading to their development in a unique macrosystem.^[1]

Theories of Development

Developmental Theories

Theories of development provide a framework for thinking about human growth, development, and learning. If you have ever wondered about what motivates human thought and behavior, understanding these theories can provide useful insight into individuals and society.

Psychosexual/Psychodynamic Stages of Development (FREUD),

AGES	STAGE NAME	DESCRIPTION
0-2	Oral	seeks pleasure through mouth (sucking, chewing) greedy, mistrustful
2-3	Anal	pleasure from excretion (feces) aggressive anal retentive
3-6	Phallic	Oedipal/Elektra complex attracted to opposite sex parent jealousy of same sex parent
6-puberty	Latency	sexual impulses overshadowed by need to adapt to environment drawn to authority figures, avoids relationship with opposite sex parent
puberty onward	Genital	sexual impulses become manifest and directed outward

Relational Cultural Theory / RCT (BAKER-MILLER) GILLIGAN?

Theory of Cognitive Development (PIAGET)

Stages of Cognitive Development

AGES	STAGE NAME	DESCRIPTION
0-2 Infancy	Sensorimotor	object permanence (can keep image in mind even if not present), cause & effect awareness, imitates others’ behavior, goal-directed behavior, Infant behavior follows this cycle: reflexive –> circular reactions –> re-creation –>means-end actions
2-6 Young Childhood	Preoperational	egocentricity, stable verbal & mental representations, single character/quality classification (“I have blonde hair”), symbolic function, animism, intuitive thought, magical beliefs, very simple reasoning
6-12 Middle Childhood	Concrete Operations	conservation of volume & length (reversibility), ordered characterization, uses simple logic beyond reasoning but limited to real objects, able to compare, increased attention span (necessary for formal education)
12+ Adolescence & Young Adulthood, onward	Formal Operations	abstract and symbolic thought, able to think about one’s own thoughts, now uses reasoning skills by rules of formal logic so can compare actual to the ideal and refer to the hypothetical, systematic logic. (Not all people go past this stage).

Separation-Individuation theory of child development in pre-Oedipal infancy - from 0 to 3 years (MAHLER)

AGES	STAGE NAME	DESCRIPTION
0-1 months	Autistic
4-5 months	Symbiosis
5-36 months	Separation-Individuation	Differention Practicing motor skills Rapproachment Constancy of self and object

Early Attachment Theories (BOWLBY)

Stranger anxiety: fearful of strangers.

Separation anxiety: fear of separation from primary caregivers.

Prolonged separation results in protest, despair, and detachment.

John Bowlby developed attachment theory. Infants become attached to adults who are sensitive and responsive in social interactions with them, and who remain as consistent caregivers for some months during the period from about six months to two years of age. When an infant begins to crawl and walk they begin to use attachment figures (familiar people) as a secure base to explore from and return to.

Parental responses lead to the development of patterns of attachment; these, in turn, lead to internal working models which will guide the individual's perceptions, emotions, thoughts and expectations in later relationships.^[2] Separation anxiety or grief following the loss of an attachment figure is considered to be a normal and adaptive response for an attached infant. These behaviours may have evolved because they increase the probability of survival of the child.^[3]

Infant behaviour associated with attachment is primarily the seeking of proximity to an attachment figure. To formulate a comprehensive theory of the nature of early attachments, Bowlby explored a range of fields, including evolutionary biology, object relations theory (a branch of psychoanalysis), control systems theory, and the fields of ethology and cognitive psychology.^[4]

Attachment Styles (AINSWORTH)

Research by developmental psychologist Mary Ainsworth in the 1960s and 70s reinforced the basic concepts of Bowlby's attachment theory, introduced the concept of the "secure base" and developed a theory of a number of attachment patterns in infants: secure attachment, avoidant attachment and anxious attachment.^[5] The Strange Situation was developed to conduct research about attachment styles.

Characteristics of Secure Attachment

Mildly upset by caregiver's absence, seeks contact upon return.

Securely attached children exhibit distress when separated from caregivers and are happy when their caregiver returns. Remember, these children feel secure and able to depend on their adult caregivers. When the adult leaves, the child may be upset but he or she feels assured that the parent or caregiver will return.
When frightened, securely attached children will seek comfort from caregivers. These children know their parent or caregiver will provide comfort and reassurance, so they are comfortable seeking them out in times of need.

Characteristics of Insecure (Anxious/Ambivalent) Attachment

Disturbed when left with stranger, ambivalent to caregiver's return.

Ambivalently attached children usually become very distressed when a parent leaves. This attachment style is considered relatively uncommon, affecting an estimated 7-15% of U.S. children. Research suggests that ambivalent attachment is a result of poor maternal availability. These children cannot depend on their mother (or caregiver) to be there when the child is in need.

Characteristics of Avoidant Attachment

No reaction to caregiver's return. ignores her/him.

Children with an avoidant attachment tend to avoid parents or caregivers. When offered a choice, these children will show no preference between a caregiver and a complete stranger. Research has suggested that this attachment style might be a result of abusive or neglectful caregivers. Children who are punished for relying on a caregiver will learn to avoid seeking help in the future.

Characteristics of Disorganized/Disoriented Attachment

Fearful of caregivers, confused facial expressions, often have been mistreated.

By Mary Main^[4] , child may cry during separation but avoid the mother when she returns or may approach the mother, then freeze or fall to the floor, or rocking to and fro or repeatedly hitting themselves. Main and Hesse^[6] found that most of the mothers had suffered major losses or trauma before or after the birth and had reacted by becoming severely depressed.^[5]

Stages of psychosocial development (ERIKSON)

Stage
Basic Conflict
Important Events
Outcome

AGE	STAGE	IMPT EVENTS	OUTCOME
0-2Infancy	Trust vs. Mistrust	Feeding	Children develop a sense of trust when caregivers provide reliabilty, care, and affection. A lack of this will lead to mistrust.
2-3 Early Childhood	Autonomy vs. Shame and Doubt	Toilet Training	Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt.
3–6 Preschool	Initiative vs. Guilt	Exploration	Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt.
6-12 School Age	Industry vs. Inferiority	School starts	Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority.
12-20 Adolescence	Identity vs. Role Confusion	Social Relationships	Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self.
20-40 Young Adulthood	Intimacy vs. Isolation	Relationships	Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation.
40-65 Middle Adulthood	Generativity vs. Stagnation	Work and Parenthood	Adults need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world.
65-death Maturity	Ego Integrity vs. Despair	Retirement and Reflection on Life	Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair.

Conflict Theory

Draws attention to conflict, dominance, and oppression in social
life.
Groups and individuals try to advance their own interests over the interests of
others.
Power is unequally divided, and some social groups dominate others.
Social order is based on the manipulation and control of nondominant groups
by dominant groups.
Lack of open conflict is a sign of exploitation.
Social change is driven by conflict, with periods of change interrupting long
periods of stability.

Note: Social workers use this theory to understand clients who are experiencing

oppression in some form or another in our capitalist society.

Stages of moral development (KOHLBERG)

Ecological theory of development (GIBSON)

Gibson asserted that development was driven by a complex interaction between environmentalaffordances and the motivated humans who perceive them. For example, to an infant, different surfaces "afford" opportunities for walking, crawling, grasping, etc. As children gain motor skills, they discover new opportunities for movement and thus new affordances.^[3] The more chances they are given to perceive and interact with their environment, the more affordances they discover, and the more accurate their perceptions become.

Gibson identified four important aspects of human behavior that develop:^[4]

Agency- self-control, intentionality in behavior
- Agency is learning to control both one's own activity and external events
- Babies learn at an early age that their actions have an effect on the environment
- For example: Babies were observed kicking their legs at a mobile hanging above them. They had discovered their kicking made the mobile move.
Prospectivity- intentional, anticipatory, planful, future-oriented behaviors
- For example: A baby will reach out to try and catch an object moving toward them because the baby can anticipate that the object will continue to move close enough to catch. In other words, the baby perceives that reaching out his/her hand will afford him/her to catch the object.
Search for Order- tendency to see order, regularity, and pattern to make sense of the world
- For example: Before 9 months, infants begin to recognize the strong-weak stress patterns in their native language
Flexibility- perception can adjust to new situations and bodily conditions (such as growth, improved motor skills, or a sprained ankle)
- Examples: Three-month-old infants laying under a mobile had a string attached to their right leg and then to the mobile so that when they moved their leg the mobile would move. When the string was switched to the left legs, the infants would easily shift to moving that leg to activate the mobile.
- Perception is an on-going, active process.

Stages of ego development (LOEVINGER)

Monday, September 17, 2012

License Exam: Professional and Therapeutic Relationships (5%)

Professional and Therapeutic Relationships (5%)

License Exam: Diversity and Cultural Competency (7%)

Diversity and Cultural Competency (7%)

Therapy in a Multicultural social environment – Although the theoretical foundations of psychology are rooted in European culture, there is a growing recognition that there exist profound differences between various ethnic and social groups and that systems of psychotherapy need to take those differences into greater consideration.^[46] Further, the generations following immigrant migration will have some combination of two or more cultures—with aspects coming from the parents and from the surrounding society—and this process ofacculturation can play a strong role in therapy (and might itself be the presenting problem). Culture influences ideas about change, help-seeking, locus of control, authority, and the importance of the individual versus the group, all of which can potentially clash with certain givens in mainstream psychotherapeutic theory and practice.^[59] As such, there is a growing movement to integrate knowledge of various cultural groups in order to inform therapeutic practice in a more culturally sensitive and effective way.^[60]

Feminist therapy is an orientation arising from the disparity between the origin of most psychological theories (which have male authors) and the majority of people seeking counseling being female. It focuses on societal, cultural, and political causes and solutions to issues faced in the counseling process. It openly encourages the client to participate in the world in a more social and political way.^[61]

Monday, September 10, 2012

License Exam: Professional Values and Ethics (11%)

Professional Values and Ethics (11%)

NASW Code of Ethics

Ethical Principles

The following broad ethical principles are based on social work’s core values of service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. These principles set forth ideals to which all social workers should aspire.

Value: Service

Ethical Principle: Social workers’ primary goal is to help people in need and to address social problems.
Social workers elevate service to others above selfinterest. Social workers draw on their knowledge, values, and skills to help people in need and to address social problems. Social workers are encouraged to volunteer some portion of their professional skills with no expectation of significant financial return (pro bono service).

Value: Social Justice

Ethical Principle: Social workers challenge social injustice.
Social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people. Social workers’ social change efforts are focused primarily on issues of poverty, unemployment, discrimination, and other forms of social injustice. These activities seek to promote sensitivity to and knowledge about oppression and cultural and ethnic diversity. Social workers strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making for all people.

Value: Dignity and Worth of the Person

Ethical Principle: Social workers respect the inherent dignity and worth of the person.
Social workers treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity. Social workers promote clients’ socially responsible selfdetermination. Social workers seek to enhance clients’ capacity and opportunity to change and to address their own needs. Social workers are cognizant of their dual responsibility to clients and to the broader society. They seek to resolve conflicts between clients’ interests and the broader society’s interests in a socially responsible manner consistent with the values, ethical principles, and ethical standards of the profession.

Value: Importance of Human Relationships

Ethical Principle: Social workers recognize the central importance of human relationships.
Social workers understand that relationships between and among people are an important vehicle for change. Social workers engage people as partners in the helping process. Social workers seek to strengthen relationships among people in a purposeful effort to promote, restore, maintain, and enhance the wellbeing of individuals, families, social groups, organizations, and communities.

Value: Integrity

Ethical Principle: Social workers behave in a trustworthy manner.
Social workers are continually aware of the profession’s mission, values, ethical principles, and ethical standards and practice in a manner consistent with them. Social workers act honestly and responsibly and promote ethical practices on the part of the organizations with which they are affiliated.

Value: Competence

Ethical Principle: Social workers practice within their areas of competence and develop and enhance their professional expertise.
Social workers continually strive to increase their professional knowledge and skills and to apply them in practice. Social workers should aspire to contribute to the knowledge base of the profession.

Monday, September 3, 2012

License Exam: Assessment and Diagnosis - Treatment Planning (11%)

Assessment and Diagnosis, Treatment Planning (11%)

Diagnosis Can Miss ADHD in Girls

http://bpd.about.com/od/glossary/g/DSM.htm
http://bipolar.about.com/cs/faqs/f/faq_dsm.htm

MULTIAXIAL DIAGNOSIS

In the DSM-IV-TR system, an individual is diagnosed on five different domains, or "axes." The multi-axial system in DSM-IV-TR was developed in part in order to capture more of the complexity surrounding psychiatric conditions.
Axis I: Clinical Disorders: Major psychiatric disorders are diagnosed on Axis I. For example, major depressive disorder and posttraumatic stress disorder disorders of learning, and developmental disabilities. Axis I tends to be reserved for major disorders that are thought to be somewhat episodic
Axis II: Personality Disorders or Mental Retardation: these are thought to be longer-standing conditions of thinking and behavior that are typically present before age 18. For example, personality disorders and Mental retardation (or MR). These are chronic conditions separated from Axis I conditions in order to allow them to be highlighted
Axis III: Medical or Physical Conditions: Axis III is reserved for medical or physical conditions that may affect or be affected by mental health issues. For example, if someone has cancer, and their illness and treatment are affecting their mental health, that would be important information to be conveyed in the diagnosis.
Axis IV: Contributing Environmental or Psychosocial Factors: Often, a psychiatric diagnosis happens in the context of major environmental or social stressors. For example, job loss, divorce, financial problems, or homelessness.
Axis V: Global Assessment of Functioning: The GAF is a number between 0 and 100 which is meant to indicate level of functioning, or a person's ability to engage in adaptive daily living. Lower scores indicate lower functioning.

Click here for the Expanded text on Multiaxial Diagnosis

Axis I is reserved for clinical disorders and developmental and learning disorders. Disorders that may be present on Axis I include:

Axis II is for personality disorders or mental retardation. Disorders that may appear on Axis II include:

Axis III is for medical and/or physical conditions or disorders. For example:

Hyperthyroidism
Mitral Valve Prolapse (MVP)

Axis IV indicates factors contributing to, or affecting, the current psychiatric disorder and treatment outcomes. These include:

Lack of an adequate support system
Social issues
Educational problems
Problems with work
Financial difficulties
Legal problems
Other psychosocial and environmental problems

Axis V is for the GAF or global assessment functioning. This is a 100-point scale that the mental health professional uses to describe the patient’s overall level of performance in usual daily activities and social, occupational, academic and interpersonal functioning.

_Source:

American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision" 2000 Washington, DC: Author.

DSM Decision Trees for Differential Diagnosis

The purpose of these decision trees is to aid the clinician in understanding the organization and hierarchical structure of the DSM-IV Classification. Each decision tree starts with a set of clinical features. When one of these features is a prominent part of the presenting clinical picture, the clinician can follow the series of questions to rule in or rule out various disorders.
I. Differential Diagnosis of Mental Disorders Due to a General Medical Condition
II. Differential Diagnosis of Substance-Induced Disorders
III. Differential Diagnosis of Psychotic Disorders
IV. Differential Diagnosis of Mood Disorders
V. Differential Diagnosis of Anxiety Disorders
VI. Differential Diagnosis of Somatoform Disorders
Click here for expanded text on Differential Diagnosis

Mental/Behavioral Health DISORDERS

Mood and Anxiety Disorders

http://ptsd.about.com/od/ptsdbasics/a/PTSDoverview.htm

http://depression.about.com/od/whatisdepression/tp/facts.htm

Personality Disorders

http://bpd.about.com/od/relatedconditions/a/Personality-Disorders.htm

The DSM-IV-TR states that Borderline Personality Disorder (BPD) is an Axis II disorder characterized by a pervasive pattern of instability of interpersonal relationships, self-image, and emotions/affects. The diagnostic criteria for BPD is that it is manifested by 5 or more symptoms, such as inappropriate, intense anger, fear of abandonment, impulsive self-damaging behaviors, suicidal threats and gestures, and chronic feelings of emptiness. People with BPD may have a tendency to themselves and others as all good or all bad, with no grey areas; this is termed “splitting.”

http://bpd.about.com/od/relatedconditions/a/Narcissistic-Personality-Disorder.htm

AUTISM
http://autism.about.com/od/whatisautism/a/symptoms.htm

Monday, August 27, 2012

Behavioral Theory (Behaviorism)

We practice with human beings in their social environments, so this comment from the founding father of Behaviorism speaks volumes about the causes of human behavior and thought, as well as methods we can employ to assist them in changing those very things that challenge them:

Give me a dozen healthy infants, well-formed, and my own specified world to bring them up in and I'll guarantee to take any one at random and train him to become any type of specialist I might select -- doctor, lawyer, artist, merchant-chief and, yes, even beggar-man and thief, regardless of his talents, penchants, tendencies, abilities, vocations, and race of his ancestors. --John Watson, 1930

Behavioral theory is based on the belief that behaviors can be measured, trained, and changed. This theory of learning is based upon the idea that all behaviors are acquired through conditioning. Conditioning occurs through interaction with the environment. Behaviorists believe that our responses to environmental stimuli shapes our behaviors. There are two major types of conditioning that produce behavior: Operant conditioning and Classical (Pavlovian or Respondent) Conditioning.

Operant conditioning

(AKA instrumental conditioning) A method of learning that occurs through rewards and punishments for behavior. Through operant conditioning, an association is made between a behavior and a consequence for that behavior. Coined by behaviorist B.F. Skinner, he believed that internal thoughts and motivations could not be used to explain behavior. Skinner used the term operant to refer to any "active behavior that operates upon the environment to generate consequences" (1953). In other words, Skinner's theory explained how we acquire the range of learned behaviors we exhibit each and every day (Learning Theory). Examples include: children completing homework to earn a reward from a parent or teacher, or employees finishing projects to receive praise or promotions. Removal of a desirable outcome or the use of punishment can be used to decrease or prevent undesirable behaviors. For example, the loss of recess privileges or additional homework as punishment may lead to a decrease in disruptive behaviors.

Reinforcement
is any event that strengthens or increases the behavior it follows:

Positive reinforcers are favorable outcomes that are presented or added after the behavior, such as praise or a direct reward.
Negative reinforcers involve the removal of an unfavorable outcome after the display of a behavior.

Punishment
on the other hand, is the presentation of an adverse outcome that causes a decrease in the behavior it follows.

Positive punishment, sometimes referred to as punishment by application, involves the presentation of an unfavorable event or outcome in order to weaken the response it follows, such as “time out.”.
Negative punishment, also known as punishment by removal, occurs when an favorable event or outcome is removed after a behavior occurs, such as the denial of recess time.

Classical conditioning

Although operant conditioning plays the largest role in discussions of behavioral mechanisms, classical conditioning (or Pavlovian conditioning or respondent conditioning) is a technique used in behavioral training in which a naturally occurring stimulus is paired with a response, then substituted with different stimulus. Eventually, the new stimulus comes to evoke the response. The two elements are then known as the conditioned stimulus and the conditioned response. Pavlov's experiments, the dog was presented with a stimulus such as a light or a sound, and then food was placed in the dog's mouth. After a few repetitions of this sequence, the light or sound by itself caused the dog to salivate.^[19]

The Little Albert Experiment (Classical conditioning by Watson)

classical conditioning

Neutral Stimulus: The white rat
Unconditioned Stimulus: The loud noise
Unconditioned Response: Fear
Conditioned Stimulus: The white rat
Conditioned Response: Fear

Family Therapy

The family is a psychological unit, in which changes in one member affect other members and the family's functioning. Family therapy is geared toward helping individual members become aware of their defensive reactions and to communicate more openly with each other; it usually focuses on present problems and their practical solutions. Families are also self-regulating and tend toward homeostasis, though returning to it may bring about additional challenges. A family is a multi-generational network, that employs its cultural beliefs. Family therapy is inappropriate in circumstances where domestic/family violence, destructive behavior, or abuse between members is present.

Types of family therapy:

Family Systems (Bowen)
Experiential (Satir, Whitaker)
- Experiential therapists are interested in altering the overt and covert messages between family members that affect their body, mind and feelings in order to promote congruence and to validate each person’s inherent self-worth. Change and growth occurs through an existential encounter with a therapist who is intentionally “real” and authentic with clients without pretense
Narrative (Epston, White)
- People use stories to make sense of their experience and to establish their identity as a social and political constructs based on local knowledge. Narrative therapists avoid marginalizing their clients by positioning themselves as a co-editor of their reality with the idea that “the person is not the problem, but the problem is the problem.”
Strategic (Haley, Madanes)
- Symptoms of dysfunction are purposeful in maintaining homeostasis in the family hierarchy as it transitions through various stages in the family life cycle.
Structural (Minuchin)
- Family problems arise from maladaptive boundaries and subsystems that are created within the overall family system of rules and rituals that governs their interactions.
Solution-Focused (de Shazer)
- The inevitable onset of constant change leads to negative interpretations of the past and language that shapes the meaning of an individual’s situation, diminishing their hope and causing them to overlook their own strengths and resources.
Psychodynamic (Scharff)
- By applying the strategies of Freudian psychoanalysis to the family system therapists can gain insight into the interlocking psychopathologies of the family members and seek to improve complementarity. Individuals choose relationships that attempt to heal insecure attachments from childhood. Negative patterns established by their parents (object) are projected onto their partners.
Communications Model (Jackson, Haley)
- All people are born into a primary survival triad between themselves and their parents where they adopt survival stances to protect their self-worth from threats communicated by words and behaviors of their family members.
Feminist (Bern)
- Complications from social and political disparity between genders are identified as underlying causes of conflict within a family system. Therapists are encouraged to be aware of these influences in order to avoid perpetuating hidden oppression, biases and cultural stereotypes and to model an egalitarian perspective of healthy family relationships.

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