Sw124 Notes For Students Chapter 5.1999-2003doc

Intro to Social Work SW124 Chapter Five Emotional/Behavioral Problems and Counseling What is Mental Illness? Medical Model and Interactional Model Medical Model views emotional and behavioral problems as mental illness, comparable to physical illness A belief that the disturbed person’s mind is affected by some generally unknown internal condition which can be due to genetics, metabolic disorders, infectious diseases, internal conflicts, unconscious use of defense mechanism, or traumatic early experiences that cause emotional fixations and prevent future psychological growth Major evidence – medical-model comes from studies that some mental disorders, such as schizophrenia, influenced by genetics – ex. twins DSM-IV Diagnosis Categories Disorders usually diagnosed in infancy, childhood, or adolescence – mental retardation, etc. Delirium, Dementia, and Amnesic and Other Cognitive Disorders - Delirium due to alcohol/drugs, Alzheimer’s, Parkinson’s, head trauma. Substance -Related Disorders – mental disorders related to abuse of alcohol, caffeine, amphetamines, cocaine, etc. Schizophrenia and Other-Psychotic Disorders – delusional disorders and all forms of schizophrenia – effect and behavior that last longer than 6 months Mood Disorders – emotional disorders such as depression and bipolar disorders Somatoform Disorders – manifest as a physical disease – hypochondria Anxiety Disorders – phobias, posttraumatic stress disorder, etc. Dissociative Disorders – part of the personality is dissociated from the rest such as dissociative identity disorder (formerly called multiple personality disorder) Sexual and Gender Identity Disorders – sexual dysfunctions, exhibitionism, fetishism, pedophilia, etc. (cross-gender identification is included only to the extent that extensive counseling is needed to determine the basis (included only to the extent that extensive counseling is needed to determine the basis if new assignment is sought) Eating Disorders – anorexia nervosa, bulimia nervosa, & compulsive overeating Sleep Disorders – insomnia, nightmares, sleepwalking, etc. Impulse-Control Disorders – inability to control certain undesirable impulses ex. Kleptomania, pyromania, pathological gambling Adjustment Disorders – adjusting to stress created by common events as unemployment or divorce

Personality Disorders – enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment Paranoid – pattern of distrust and suspiciousness, such that others’ motives are interpreted as malevolent Schizoid – pattern of detachment from social relationships and a restricted range of emotional expression

Schizotypal – pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior Antisocial – pattern of disregard for and violation of, the rights of others Borderline – pattern of instability in interpersonal relationships, self-image, and affects and impulsivity Histrionic – pattern of excessive emotionality and attention seeking Narcissistic – pattern of grandiosity, need for admiration, lack of empathy Avoidant – pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation Dependent – pattern of submissive and clinging behavior related to an excessive need to be taken care of Obsessive-Compulsive – pattern of preoccupation with orderliness, perfectionism and control Interactional Model The idea that mental illness is a myth-that it does not exist 3 types of emotional/behavioral disorders Personal disabilities – excessive anxiety, depression, fears, feelings of inadequacy – (unwanted emotions) (not disease) Antisocial acts- bizarre homicides and other social deviations Deterioration of the brain with associated personality changes – Alzheimer’s disease, arteriosclerosis, chronic alcoholism, AIDS, or serious brain damage caused by an accident Medical labels have adverse effects – people believe that have a disease for which there may be no known cure - give people an excuse to not take responsibility for their behaviors Labeling as the Cause of Chronic “Mental Illness” Despite extensive research the determinants of chronic mental disorders are largely unknown Everyone at some time or another violates what are considered social “norms” – usually this is not considered mental illness When that violation is perceived by others as “abnormal” the offenders are labeled “mentally ill” and the person also begins to define themselves as mentally ill If they try to return to their previous behaviors they are viewed with suspicion The more they are related to as mentally ill the more they begin to accept the diagnosis The Homeless 25% to 50% of the homeless are thought to suffer from serious and chronic form of mental illness I. Discharged from institutions without the support they need Many states have a deinstitutionalization program of simply drugging people and dumping them into the street This was not the original intent of the mental health act Cutbacks in social services by the federal government prevents communities from providing for this population Solutions including – low-cost housing, job services for those with emotional problems, job placement and training As a society presently we prefer to pretend they do not exist Civil Rights Striking an acceptable balance between the disturbed person’s right to liberty and society’s right to safety and protection is complex In some mental hospitals patients do not receive adequate treatment – this is a violation of the Mental health act of 1964 Decisions about providing treatments such as electroconvulsive therapy raise civil rights questions and severely disturbed are often unable to make rational choices about their own welfare Federal court decisions have held that mental illness is not a sufficient basis for denying liberty and that

hospitalized mental patients have a right to either adequate treatment or release Plea of Innocent by Reason of Insanity Dan White – found innocent by reason of insanity – even though testimony clearly showed murders had been carefully planned – Twinkie Defense Among psychiatrists there is nothing approaching a consensus on what constitutes insanity Criminals are able to manipulate the system Some states are revising laws – some to eliminate the insanity plea – others have a two-step process Use of Psychotropic Drug Psychotropic drugs include tranquilizers, antipsychotic drugs (such as Thorazine), and antidepressants Psychotropic drugs do not “cure” emotional problems, but are useful in reducing high levels of anxiety, depression, and tension. They also reduce some symptoms such as the hearing of voices and hallucinations Because they only provide temporary relief many authorities urge that patients also receiving counseling or psychotherapy to help resolve the underlying emotional difficulties

Managed Health Care Managed Health care is a generic term used to describe a variety of methods of and financing healthcare services designed to contain the costs of service delivery while maintaining a defined level of quality of care (HMO) There has been severe reductions in the number of days that managed health care will reimburse impatient treatment centers More and more people with emotional and behavioral problems are increasingly only receiving drug therapy than “talk” therapy Social Structure and Mental Illness Social Class – the poor are more likely to be labeled mentally ill – they are less likely to seek treatment early Urbanization – inner-city area may have a higher rate of mental illness – overcrowding – quality of life Age – elderly are more likely to have emotional problems, particularly depression – low status – brain degeneration – grief Marital Status – single, divorced, or widowed have higher rates – unmarried men have a higher rate than unmarried women Sex – equal but nature of diagnosis varies – women, anxiety, depression, phobias and to be hospitalized; men, personality disorder – most psychiatrists are men and are more apt to consider sexual promiscuity or aggressive behavior in women a mental order as compared to men Race – compared to Whites, African Americans are more like to be diagnoses as mentally ill and there’s a higher rate of hospitalization – AA under greater psychological pressure, many in lower socioeconomic status, psychiatrist are White Social Work and Mental Health Many social agencies in addition to the community mental health centers provide psychotherapy to people, schools, family counseling agencies, social service departments, hospitals, adoption agencies, probation and parole depts. SWs who want to be involved in private practice must have a master’s or doctoral degree in social work from an accredited graduate school, two years or 3,000 hours of postgraduate clinical social work experience, supervised by a clinical social worker, active membership in the Academy of Certified

Social Workers or a state license that requires an examination A skilled counselor has knowledge of (a) interviewing principles and (b) comprehensive and specific treatment approaches Phases of Counseling (1) Building a Relationship (2) exploring problems in depth (3) exploring alternative solutions

Building a Relationship Seek to establish a nonthreatening atmosphere You need to present yourself as a knowledgeable, understanding person Be calm – do not laugh or express shock when the counselee begins to open up about problems Generally be nonjudgmental and nonmoralistic – show respect for the counselee’s values and do not try to sell your own values View the counselee as an equal, (many rookies make mistake of being superior and creating a superior/inferior relationship) Use “shared vocabulary” – not slang or coping – but use words that the counselee understands and that are not offensive Tone of voice should convey the message that you empathetically understand and care about the counselee’s feelings Keep confidential what the counselee has said If possible refrain from counseling friends or relatives because emotional involvement interferes with the calm, detached perspective that is needed to help clients explore problems and alternative solution Exploring Problems in Depth A counselor should take the time to discover the client’s in depth opinions and feelings on a course of action before suggesting solutions The Counselor and the clients need to examine such areas as the extent of the problem, its duration, its causes, the counselee’s feelings about the problem, and the physical and mental capacities and strengths the counselee has to cope with the problem When a problem area is identified, a number of smaller problems may occur, explore all these subproblems – usually it helps to solve a subset problem first. Ask the client which of those subset problems does he/she find the most pressing Convey empathy not Sympathy Trust your instincts. The most important tool you have as a counselor is yourself – rely on your feelings, perceptions and training When you believe a client has touched on an important area of concern, you can encourage further communication by nonverbally showing interest or pausing (don’t be afraid to pause), using neutral probes, summarizing what the client is saying, reflecting feelings. When pointing out a limitation that a client has, also mention and compliment him or her on any assets. Watch for nonverbal cues Be honest Listen attentively to what the client is saying – try to hear the words not from your perspective but from the client’s.

Exploring Alternative Solutions It is almost always best for the counselor to begin by asking something like “Have you thought about way to resolve this?” If the client not thought of certain viable alternatives, the counselor should mention these, and the merits and shortcomings to these alternatives The client usually has the right to self-determination – counselor’s role is to help the client clarify and understand the likely consequences of each alternative – at the same not to give advice or choose the alternative “Have you thought about as opposed to I think you should” Counseling is done with the client, not to or for the client – client should take responsibility for those task that they have the capacity to accomplish Form explicit, realistic “contracts” with counselees – when the counselee selects and alternative, they should clearly understand the goals, tasks and who will do what If the counselee fails to meet the terms of the “contact” do not punish, but do not accept excuses. Ask the clients if they wish to continue to try and meet their commitment If the counselee fails to meet the terms of the “contact” do not punish, but do not accept excuses. Ask the clients if they wish to continue to try and meet their commitment A counselor should seek to motive apathetic clients – sometimes clients do not have the motivation to fulfill contracts One way to increase motivation is to clarify what will be gained by meeting the commitment when a commitment is met reward the clients with an affirmation If necessary help the client to “role-play” the tasks – this can be done by having the counselor at first role play the client’s role and then the client plays herself When to Refer to Another Counselor If the counselor feels that she or he is unable to empathize with the client If the counselor feels that the counselee is choosing alternatives that conflict with the counselor’s basic value system If the counselor feels that the problem is of such a nature that she or he will not be able to help If a working relationship is not established A competent counselor knows that she or he can work with and help some people but not all.