Ch. 11 treatment & intervention

1. Ch. 11 – Treatment &
Intervention

2. Preparing for Treatment
If you’ve successfully completed previous steps, then you and your
client will be ready to begin the TREATMENT phase of the helping
process:
◦ Intake & Engagement (Ch. 8)
◦ Assessment (Ch. 9)
◦ Problem Identification, Planning & Contracting (Ch. 10)
◦ INTERVENTION (Ch. 11)

3. Selecting Treatment Options
1. Review treatment options appropriate for the problem &
goals
2. Assess evidence-based practices for treatment options
considered
3. Identify interventions & techniques that BEST FIT client’s
needs
4. Honestly assess YOUR practice skills set and ability to
implement the treatment option needed

4. Context of Treatment & Intervention
 Cultural Context
 Internal Culture – psychological, emotional,
cognitive, and intellectual capabilities of client
 Agency Context

5. Client Motivation
What motivates clients to actively engage in treatment???
Whose responsibility is it to make sure the client becomes
invested and remains engaged in treatment???
THERAPEUTIC ALLIANCE…

6. Client Motivation
RESISTANCE to change – what does this mean? What does it
look like? Doesn’t this apply to all of us??
In social work, we often want to label clients as “resistant to
change” when it’s a lack of skill on our part of effectively engage
the client or overcome barriers to change…
Resistance to change is often signaled by “Yes, but…” “I’ve tried
that and it hasn’t worked…” “Well, I would but…”

7. Motivational Interviewing
“Brief therapeutic approach used to help clients
resolve resistance or ambivalence toward change”.
1. Express empathy to clients
2. Awareness of discrepancies
3. Acceptance of resistance
4. Supporting client’s self-efficacy

8. Motivational Interviewing
Read the case study about Tania, a battered woman
whose social worker at a shelter for victims of
domestic violence uses motivational interviewing. Do
you think you could use this technique effectively?
Why or why not? Do you see how it could be
beneficial in helping Tania make good (but tough)
decisions about her future???

9. Building Client Capacities & Coping Skills
Coping Skills Training (CST) helps strengthen clients’ existing skills
and develop new strategies for effectively cope with situations that
put them at risk of engaging in harmful/detrimental behaviors.
Read the examples in the book about approaches to CST…

10. Brief Treatment Strategies & Techniques
Brief psychodynamic therapy – read the Case Example in Box 11.3
Cognitive-Behavioral Therapy (CBT) – example in Box 11.4, and
elaborations in Box 11.5 and techniques in 11.6
Solution-Focused Brief Therapy (SFBT) – read Case Example in Box
11.8 – See Sample Questions (Box 11.7) – POWERFUL!!!

11. Box 11.6
Cognitive-Behavioral Therapy Techniques
Capturing automatic negative thoughts—underlying negative core beliefs about ourselves that we may not be fully conscious of
because of their constant presence. The social worker can help the client capture these thoughts through the use of homework
activities, such as keeping a diary or record of recurring thoughts. In doing so, negative core beliefs about the client that need to
be restructured will begin to emerge.
Cognitive restructuring—replacing clients' self-defeating thoughts and cognitive distortions with more accurate and life-
enhancing thoughts using a number of techniques, such as challenging client beliefs with evidence, teaching clients to assess
beliefs with evidence, having clients substitute positive self-talk, and deconstructing beliefs in discussions with the social worker.
Decentering—replace the client's faulty belief that he or she is the center of attention of others who know what he or she is
thinking and feeling. Through discussions and use of evidence, the social worker helps the client decenter, and the client is thus
relieved of the anxiety he or she experiences when he or she feels he or she is being watched and judged by others.
Redefining—replace clients' negative interpretation of an event with a more positive interpretation. For example, in response to
failing a driving test, an adolescent concludes, "I'm a terrible driver." A more positive and useful redefining of this event might be
"I need more practice at driving with an experienced driver."
Semantic analysis—teasing out the meaning in automatic negative thoughts that can then be challenged with evidence and
redefined using more accurate language, such as "What does it mean when I say I'm a terrible student?," "What makes me a
terrible student?," "What is the basis of this conclusion?," "In what areas do I do well as a student?," or "In what areas do I need
support?" Following this line of analysis, the student may come to the conclusion that he or she needs practice at taking time-
limited tests. This is a helpful insight for improving one's grades.
Sources: Boyle, Grafton, Mather, Smith, and Farley (2009); Satterfield and Crabb (2010); Walsh (2013).

12. Box 11.7
Solution-Focused Brief Therapy—The Language of
Solutions: Sample Interview Questions
1. THE MIRACLE QUESTION:
"Imagine a miracle occurring tonight that would (sufficiently) solve the problem which brought you here, but you were unaware of this as
you were asleep. In the morning, how would you notice that this miracle had taken place? What would be different? What would you be
doing differently? Who would be the next person to notice that the miracle has happened? How would this person notice? How would he
or she react?"
2. SCALING QUESTIONS:
On a scale of 1 to 10, with 10 meaning you have every confidence that this problem can be solved and 1 meaning no confidence at all,
where would you put yourself today?On the same scale, how hopeful are you that this problem can be solved? What would be different
in your life when you move up just one step?
3. A FOCUS ON SOLUTIONS RATHER THAN THE PROBLEM:
How are things better?
4. EXPLORING EXCEPTIONS:
How will you know when our work together has helped? How would you say you are different when you are a little bit
less depressed? What would it take to move up one notch on the scale? When you force yourself to get out of bed and
walk the kids to school, what do you suppose your children will notice that's different about you?

13. Solution-Focused Brief Therapy
In their work together developing SFBT, deShazer and Berg (1997) discovered
that when SFBT social workers engaged in three specific types of practice
behaviors, clients were significantly more likely to discuss change, solutions, and
resources. These behaviors included:
 Eliciting questions—What would you like instead of the problem? What is
better?
 Questions about details—What exactly did you do differently?
 Verbal rewards—Giving compliments and asking competency-based questions,
such as "How did you manage to do that?" and "Where did you get that good
idea?" (Bannink, 2007, p. 88)

14. Summary
 Preparing for client treatment ensures the best alignment of interventions with client needs and desired outcomes.
 The selection of treatment modalities should be in alignment with the goals and time frames set out in the contract with
the client.
 Contextual factors of treatment can include the emotional and psychological states of the client, the client's
intellectual/cognitive abilities, cultural beliefs and practices, agency rules and practice orientation, treatment setting,
family context, and social support networks.
 Client motivation keeps the client engaged in treatment and improves client outcomes.
 Resistance to change is a common human response.
 Motivational interviewing can help clients resolve resistance or ambivalence toward change.
 Building client capacities and coping skills is essential for helping clients in creating a functional, self-sustaining life as
well as helping to restore a sense of self-efficacy and improved self-esteem.
 Brief treatment with clients has become the norm in recent years. Three commonly used therapies in social work
practice are 1) brief psychodynamic therapy, 2) cognitive-behavioral therapy, and 3) solution-focused brief therapy.