Transcript Multicultural Practi..

Practice Framework
Meeting 1
© Cheung, M., & Leung, P. (2008). Multicultural practice and
evaluation: A case approach to evidence-based practice.
Denver, CO: Love Publishing Co.
Instructors who adopt this book may use the PowerPoints to
teach your course without prior permission. Please
address questions and comments to [email protected].
1
© Love Publishing: Monit Cheung
& Patrick Leung
Quotes of the Day
2

“There's always a hole in theories
somewhere if you look close enough.”—
Mark Twain (Writer, 1835–1910)

“In making theories, always keep a
window open so that you can throw one
out if necessary”—Bela Schick
© Love Publishing: Monit Cheung
& Patrick Leung
Choosing Theories for Practice

3
Why?
http://www.idrc.ca/fr/ev-27441-201-1-DO_TOPIC.html
© Love Publishing: Monit Cheung
& Patrick Leung
Reason #1: Evidence-Based Practice




4
Clinical practice is fragmented by over 400 “theories” or
systems of psychotherapy.
Many of these “theories” often claim superior
effectiveness without controlled research.
Comparative analyses will find strengths and limitations
when theories are applied in various situations.
Understanding each theory will find an integrative
structure for practice.
© Love Publishing: Monit Cheung
& Patrick Leung
Reason #2: Fitting Your Style


5
You may feel more comfortable with some
techniques while feel uneasy with others.
You will try different theories to identify
techniques that help you expand your
therapeutic integration.
© Love Publishing: Monit Cheung
& Patrick Leung
Reason #3: Best Practice


Each of your clients is unique.
You will find the best practice approaches
through familiarity with various theories so
that you will work effectively
–
–
–
6
with diverse client populations,
with diverse situations and problems, and
in diverse practice settings.
© Love Publishing: Monit Cheung
& Patrick Leung
Importance of Using Theories
Changes in
Function
and
Structure
Ability to
relate to
others and
society
7
Adaptation
Goal Attainment
Identifying
Resources
and
Constraints
FEEDBACK
Integration
Pattern Maintenance
Ability to continue
proper functions
© Love Publishing: Monit Cheung
& Patrick Leung
Importance of Theories in Social Work
Practice
Changes in
Function
and
Structure
Ability to
relate to
others and
society
8
Setting up
Goals
& Objectives
Problem
Definition
Identifying
Resources
and
Constraints
SOCIAL WORK
PROCESSES
Evaluating
Outcomes
Identifying Interventions
Ability to continue
proper functions
© Love Publishing: Monit Cheung
& Patrick Leung
Integration of Theories
Psychodynamic
Experiential
Relationship
Cognitive
Behavioral
System
9
© Love Publishing: Monit Cheung
& Patrick Leung
Integration of Theories
Psychodynamic
Thinking
Experiential
Relationship
Feeling
Cognitive
Behavioral
Doing
System
ThinkingFeelingDoing
10
© Love Publishing: Monit Cheung
& Patrick Leung
Integration of Theories
Psychodynamic
Thinking
Insight
Experiential
Relationship
Feeling
Awareness
Cognitive
Behavioral
Doing
Change
System
ThinkingFeelingDoing
Self Actualization and
System Change
11
© Love Publishing: Monit Cheung
& Patrick Leung
Transtheoretical Framework:
Stages of Change
1.
2.
3.
4.
5.
6.
12
Precontemplation: No intention to change behavior in the
foreseeable future; unaware or underaware of problems
Contemplation: Aware of the existence of a problem and seriously
thinking about overcoming it; not yet made a commitment to take
action
Preparation: Combines intention and behavioral criteria with an intent
to take action, knowing past efforts have been unsuccessful
Action: Modifies behavior, experiences, or environment in order to
overcome problems, with considerable commitment of time and energy
Maintenance: Works to prevent relapse and consolidate the gains
attained during action
Termination: Identify future goals for change and close the case
file.
© Love Publishing: Monit Cheung
& Patrick Leung
Therapeutic Process


13
Theories of personality & psychopathology tell us
what has to be changed; theories of process tell us
how change occurs
Traditional interventions often assume that individuals
are ready for an immediate and permanent behavior
change, while transtheoretical models appreciate
human diversity as a factor to determine appropriate
interventions.
© Love Publishing: Monit Cheung
& Patrick Leung
Practice–Evaluation Integration
Cheung & Leung, p. 56

Problem Definition
Resources and
Constraints
Psychosocial
Assessment
Intervention
Outcome Evaluations
14
© Love Publishing: Monit Cheung
& Patrick Leung
Therapeutic Measures
Intrapersonal conflicts
– Anxieties & defenses
– Self-esteem problems
– Personal responsibility
15
Interpersonal conflicts
– Intimacy & sexuality
– Communication
– Hostility
– Control of others
© Love Publishing: Monit Cheung
& Patrick Leung
Therapeutic Measures
Individuo-social conflicts
– Adjustment vs.
transcendence
– Impulse control
16
Beyond conflict to
fulfillment
– Meaning in life
– The ideal person
© Love Publishing: Monit Cheung
& Patrick Leung
Standardized Measures

URICA (Long Form): University of Rhode Island
Change Assessment
http://www.uri.edu/research/cprc/Measures/urica.htm
–

ASK: Working with People of Diverse Cultures
(Cheung & Leung, 2008, p. 75)
–
–
17
Please think about an issue that you may want to work on
and complete this form (without any intervention)
Please complete this instrument before next week.
Then complete this same instrument every week to reassess your ASK competencies.
© Love Publishing: Monit Cheung
& Patrick Leung
Case Approach







18
Identify the problem
Assess current resources or constraints
Assess the clients and families
Set goals and objectives
Implement the plan
Evaluate the plan
Close the case
© Love Publishing: Monit Cheung
& Patrick Leung
Assessment: Similarities







19
Family background, communication
Definitions of marriage life
Role & expectations, values, priorities
Definitions of the family
Desire to continue relationships
Identify “normal” developmental issues
Prioritize vulnerability and attention
© Love Publishing: Monit Cheung
& Patrick Leung
Assessment: Differences








20
Cultural backgrounds
Compare expectations
Gender differences
Perceptual differences
Past vs. present focus
Upbringing
Communication skills & patterns
Social justice issues (e.g., poverty, discrimination)
© Love Publishing: Monit Cheung
& Patrick Leung
Case of Joe and Mary’s Family

Intake: This family is composed of Joe (42), Mary
(38), and their two children, Ami (16) and Kevin (8).
The couple has been married for 17 years. In the
past two years, they have been experiencing
communication difficulties with their children and are
therefore seeking help to “glue” the family back
together. Joe is a mechanical engineer and Mary is a
substitute school teacher who has recently been
attending a graduate social work program. They
describe themselves as a middle-class family.
21
© Love Publishing: Monit Cheung
& Patrick Leung
Case of Joe and Mary’s Family

Initial Assessment: Joe has expressed complaints about Mary’s
inconsistent parenting style. He disagrees with how Mary
handles the family’s finances and the unreasonable spending of
their children. At the same time, Mary has presented
symptoms of emotional distress with no recognized physical
cause. Mary feels that both children are concerned about her
constant arguments with Joe, and the children seem to have
trouble concentrating on their studies. Ami and Kevin disagree
with their parents and believe that the issue lies within their
parents; they are willing to attend family counseling with their
parents in an effort to clarify their parents’ miscommunication.
The family has not had a shared activity for many years and the
children’s social activities have been limited.
22
© Love Publishing: Monit Cheung
& Patrick Leung
Bossy
Authoritarian
John
70
Rebecca
68
Peter
64
Quiet
Minister (Stroke in
2004)
Edith
59
Homemaker
m 1960; d 1973
m 1976
Caretaker
“Perfect
Autistic
child” Ann
Bianca
36
33
Fun-maker
Joan
46
Ann
44
Move to CO
in 2004
Baby
Steven
30
Caretaker
d 1981
Joe
42
Back to school
in 2004
Mary
38
m 1988
Rebellious
Ami
16
23
Baby
Kevin
8
Genogram of the Smith’s Family, 2006
© Love Publishing: Monit Cheung
& Patrick Leung
Mary’s DSM Diagnoses—
An Example





24
Axis I: Clinical disorder
Axis II: Personality disorder
Axis III: General medical conditions
Axis IV: Psychological & environmental
problems
Axis V: Global assessment of
functioning
© Love Publishing: Monit Cheung
& Patrick Leung
Mary’s
Axis I: Clinical Disorders
300.01 Panic Disorder
300.04 Dysthymic Disorder
313.82 Identity Problem
307.1 Eating Disorder: Anorexia
Nervosa–Binge Eating Type
25
© Love Publishing: Monit Cheung
& Patrick Leung
Mary’s
Axis II: Personality Disorders
309.28 Adjustment Disorder with Mixed
Anxiety and Depressed Mood
26
© Love Publishing: Monit Cheung
& Patrick Leung
Mary’s Axis III: General Medical
Conditions
None
Unexplained Headaches
27
© Love Publishing: Monit Cheung
& Patrick Leung
Mary’s Axis IV: Psychosocial &
Environmental Problem
V61.1
Partner Relational Problems
Want to Complete Graduate School
28
© Love Publishing: Monit Cheung
& Patrick Leung
Mary’s Axis V: Global Assessment of
Functioning
GAF=60 Moderate Symptoms
29
© Love Publishing: Monit Cheung
& Patrick Leung
Course Expectations
Draw your hand on a piece

of paper. On each finger,
write down:
 Your name
 One of your unique
characteristics
 One specific thing you
expect to learn from this
course
© Love Publishing: Monit Cheung & Patrick
Leung
30
Daily Affirmation

Stop for a moment and think “JOY”. And
let that thought pour over you. Stop for a
moment and think “LOVE” and let those
feelings pour over you. Wherever you
are, whatever you are doing, at any time
in any day, just stop for a moment.
Fishel, R. (1988). Time for joy. Deerfield Beach, FL: Health Communications.
31
© Love Publishing: Monit Cheung
& Patrick Leung
References
• American Psychiatric Association (APA). (2000). Diagnostic
and statistical manual of mental disorder: DSM-IVTR. Washington, DC: Author.
•
•
•
•
•
Cancer Prevention Research Center. (2007). Summary overview of
the transtheoretical model.
http://www.uri.edu/research/cprc/transtheoretical.htm
Change Assessment Measure. (2007). University of Rhode Island
Change Assessment.
http://www.uri.edu/research/cprc/Measures/urica.htm
Cheung, M., & Leung, P. (2008). Multicultural practice and evaluation:
A case approach to evidence-based practice. Denver, CO: Love.
McGoldrick, M., Gerson, R., & Petry, S. (2008). Genograms:
Assessment and Intervention. New York: Norton.
Prochaska, J. O., & Norcross, J. C. (2007). Systems of
psychotherapy: A transtheoretical analysis. Pacific Grove, CA:
Brooks/Cole. Reviewed at http://www.wadsworth.com/cgiwadsworth/course_products_wp.pl?fid=M20bI&product_isbn_issn=978
0495007777&discipline_number=7
© Love Publishing: Monit Cheung
& Patrick Leung
32