Best Practices

HERE is an incredible case study of an 11-yr-old little boy named Hamad with PTSD (caused by war). By using SSD as a research technique, Hamad and his therapist were able to bring him to a reduction of his acute symptoms.

Goal for Hamad: improve social, and behavioral functioning; reduce tension.

Objectives for Hamad:

Reduce stress

Reduce nightmares / improve sleep

Increase social support

Activities engagement to increase self esteem and social skills

Express feelings of fear, guilt, and anxiety

First Treatment Phase / Intervention (B1)

Art therapy for feelings expression

Analytic and Cathartic technique for nightmares. Describing the event and the feelings, then describing dreams — sw helped attach meanings to the parts of the dreams. Dream journal.

Group Counseling: activities group for discussion, games, soccer, and art projects.

Family Involvement: daily discussions and encouraging him to oick movie night and decide where to go on vacation. They monitored his behavior at home. Dad went to school and spoke with teachers. Brother helped with school work.

Phase 2 (A2/B2) Symptoms were assessed again using the same technique as Phase 1: Family Observation & CPTSD-RI … And in the second baseline, A2 intervention was withdrawn for a period of three weeks during which Hamad and his father attended clinic. During this time Hammad continued to meet with group, but no structured activities, just talking about different subjects.

The second intervention phase B2 continued for 4 weeks Hamad received the same interventions as were applied in B1 plus:

The Story-Line Alteration Procedure for treatment of nightmares. This intervention focuses on diffusing the energy of the nightmare by creating new insights; guided visualization techniques.

Results:

Visual significance

Statistical significance

Practical significance

Effective reduction of symptoms but not elimination.

HERE.Studies have demonstrated the effectiveness in reducing suicidality with dialectical behavioral therapy and cognitive behavioral therapy. The Collaborative Assessment and Management of Suicidality (CAMS) is a framework for working with suicidal patients independent of therapeutic orientation, for suicide-specific assessment and treatment of a patient’s suicidal risk. CAMS was also significantly linked to decreases in primary care and emergency department utilization room settings. It is a flexible approach that can be used across theoretical orientations and disciplines for a wide range of suicidal patients across treatment settings and different treatment modalities.

The clinician and patient engage in a highly interactive assessment process and the patient is actively involved in the development of their own treatment plan. Every session of CAMS intentionally utilizes the patient’s input about what is and is not working. All assessment work in CAMS is collaborative; seeking to have the patient be a “co-author” of their own treatment plan.

HERE This study examines whether rumination-focused cognitive behavior therapy (RF-CBT) alleviates symptoms of anxiety, increases behavioral activation, or increases global functioning among adolescents with a history of Major Depressive Disorder (MDD). RF-CBT directly teaches adolescents to recognize rumination or “when you get stuck in your head” and to notice the influence this has on their mood. This psychoeducation component includes noticing personal triggers to ruminate, as well as opportunities to shift/change any situations that tend to increase rumination, to reduce the habit. Adolescents were taught to be Active, Specific, and Kind (ASK) when thinking about oneself, rather than ruminative, which tends to be passive, abstract, and a critical form of thinking. Adolescents learn about their cycle of emotions and that the habit of rumination gets them stuck at thinking and feeling, which can make it harder to take action and has consequences. At each session, adolescents participated in a mindfulness exercise to show how to use your attention to shift into a different way of being. Mindfulness exercises included three-part breath, the body scan, progressive muscle relaxation, lovingkindness, the wave exercise, and others as appropriate. Another key skill taught is to change “Why?” questions to “How?” questions because abstract “Why?” questions lead to impaired problem solving, greater negative overgeneralization, and greater emotional reactivity.

HERE Research has demonstrated that rates of depression are elevated among lesbian, gay, bisexual and transsexual (LGBT) people as a result of social stigmatization. This study tested a cognitive behavioral therapy-based group intervention for LGBT people living with depression, which was delivered based on anti-oppression principles and included sessions on coming out and internalized homophobia.

Each session reviewed an educational component of the CBT model. In the first session, clients were introduced to the model and taught how thoughts, moods, physical reactions, and behaviors all interact within their environment or within a particular situation to create and maintain symptoms of depression. Group members actively participated in each session by completing the exercises, drawing upon their own lived experiences. Homework was assigned at the end of each session. During sessions, group members reviewed their homework from previous sessions, shared their experiences, gave each other feedback, and furthered their understanding about the relationship between their thoughts and their moods.

HERE Key facet of assessment (and evaluation) is the ‘problems list’. Collaboratively listing problems can organize and bring clarity around issues that were disorganized and vague before. It’s also useful to have a problems list for monitoring progress. The creation of a Problems List can be valuable for tracking triggers that can lead to problem-behavior. By referencing the list, we can better address with appropriate intervention(s).

HERE Process recordings are helpful to the practitioner but tell us nothing about the clients experience. This is a case for client participation in Practitioner evaluation... “clients and clinicians are encouraged to work together to identify problems, form treatment goals, and resolve problems”

This is a study of soliciting the client’s feedback and the dissection and learnings from how that went…. Where the practitioner and client were aligned, and where they were not. It articulates the success of bringing the client into the evaluation process.

Stronger connections were felt by the client when the practitioner showed more of their own humanness and struggle – the collaboration of problem-solving together strengthened the bond in the client/practitioner relationship. Judgments, assumptions and premature conclusions were all markedly unwelcome and unhelpful to the client by their own assessment. Client takes the ‘next steps’ and assigns the meaning they wish and draws the conclusion they wish.

HERE The complexity and emotional demands inherent in social work often come with physical and mental ill health, sickness, absence and attrition, and a range of other negative side effects such as burnout, emotional exhaustion, compassion, fatigue, and secondary trauma.

This article emphasizes the benefits of emotional resilience among social workers. Social work requires strong, coping, adapting, and personal development. The importance of optimism, effective coping skills and self-care has been emphasized. Factors that mediate between the self and the practice include support from supervisors and colleagues, coping and problem-solving skills, effective boundary setting and developmental learning. Reflective ability is also a fundamental aspect of emotional literacy that has been found to underpin successful coping and resilience.

Compassion is essential to effective health and social care. Compassion for the self comprises three elements: self-kindness (feelings of warmth, acceptance and understanding towards the self), common humanity (a recognition that personal suffering and failure is part of the shared human experience) and mindfulness (taking a balanced and non-judgemental approach to experiencing negative emotions).

Emotional self-efficacy is a key aspect of resilience in social work. Particular benefits were found for emotional self-efficacy, which encompasses the ability to perceive and understand emotion in the self and others, appreciate the complexity of emotions and use emotions to facilitate thought.

Aspects of emotional literacy are a powerful predictor of psychological well-being.

HERE This is a study that measured the effectiveness of a trans diagnostic prevention program, super skills for life (SSL) and children with anxiety issues. It’s a great resource for measurements available for this population. SSL is based on the principles of CBT, behavioral action, social skills, training, and uses video feedback and cognitive preparation as part of treatment. Results were positive. Anxiety symptoms were significantly reduced. Also had a positive effect on hyperactivity, conduct, and peer problems, although it took longer for these effects to occur.

Several questionnaires were used in the study as measures:

Social skills questionnaire, SSQ measured social skills.

Rosenberg self-esteem scale was used to measure child’s self-esteem.

Child anxiety impact scale CAIS-C was used to measure anxiety related difficulties in school, social and home family domains.

Spence children’s anxiety scale (SCAS 1998) was used to measure symptoms of anxiety disorders, including separation anxiety, social anxiety, obsessive, compulsive, manic panic disorder, specific fear, and generalized anxiety disorder. Likert type scale.

Strengths and difficulties questionnaire (SDQ Goodman, 1997) was used to measure children’s general difficulties and positive attributes, including emotional symptoms Conduct problems, hyperactivity peer problems and prosocial behavior.

Performance questionnaire, (PQC), was used by children to rate their performance, and how they felt during a speech.

Behavioral signs of anxiety scale was used to measure behavioral indicators of anxiety during the speech task.

HERE Gender and sexual orientation are complex and salient aspects of youths’ identities and directly impact social, emotional, and behavioral functioning. Therefore, an important part of culturally competent treatment with LGBTQ clients is the comprehensive assessment of any facets of identity that should be incorporated into treatment planning. Because LGBTQ individuals often experience microaggressions early in the treatment process, the intake process presents an opportunity to avoid pitfalls and create a strong therapeutic relationship as the foundation for the rest of treatment. Clinicians should be prepared to assess the relevant strengths and difficulties of all young clients, but must also be aware of specific areas of assessment for LGBTQ clients.

HERE This article discusses core concepts of cultural competence for psychotherapists to consider… specifically whether Western concepts of mental illness and its interventions are culturally valid or relevant in other societies.

This article critically examines psychotherapy from a cultural competence perspective by: (I) describing a set of core concepts of cultural competence; (II) identifying core components of culturally competent psychotherapy; and (III) proposing a three-tier cultural analysis of psychotherapy. This complements the cultural adaptation of evidence-based therapies providing care to diverse communities.

An understanding of diverse cultures (gay culture, deaf culture, youth culture, disability culture, etc.) can help therapists gain an appreciation of the presenting issues. Cultural Competence can be divided into three interacting levels: Macro = the societal level; Mezzo = the institutional or programmatic level; and Micro = the individual clinical level.

HERE This is a dissertation> Current findings espoused bereaved siblings who had poorer lifespan sibling relationships were more likely to experience higher levels of prolonged grief, while individuals who had stronger lifespan siblingship articulated higher levels of normative grief.

Grief Support Links:

For participants in the United States

1. Compassionate friends

Contact details: https://www.compassionatefriends.org/

2. Grief.com

Contact details: https://grief.com/grief-support-group-directory/

3. National Suicide Prevention Lifeline

Contact details: +1-800-273-TALK (8255) 24 hours

4. National Hopeline Network

Contact details: +1-800) 442-4673

5. Crisis Text Line

Contact details: Text DBSA to 741741 24 hours.

HERE Somewhere between avoidance and floundering there could be a place that allows a griever to sit with their grief without being totally and completely swept away by it.

Overworking, over caring for others, abuse of drugs & or alcohol, traveling and never staying put, isolating and avoiding all triggers… KEY POINT: grief is patient. There is nothing in our lives more patient than grief — it will sit and wait for acknowledgement. Sometimes healing doesn’t begin until YEARS after a loss.

HERE is an article from GoodTherapy.org with some helpful guidance on how best to terminate work with a client.