Today, mental illness is recognized as a health problem' This has not always been the case' Until th

1
Introduction

• Today, mental illness is recognized as a health
  problem. This has not always been the case. Until
  the eighteenth century, those with mental health
  disorders were viewed as witches, and the
  problem was one of purity. By the late eighteenth
  century, having attributed insanity to have
  come from evil, a transformation of thought
  regarding mental illness occurred from one of a
  supernatural origin to one of some human ailment.
  The first public mental asylum opened in the
  United States in 1773, and within the next 100
  years, 73 mental hospitals were constructed.
  Insanity and commitment development
  determinations were made by the local judiciary.
  Prior to the development of the mental asylum,
  the mentally ill were treated as paupers and
  confined in almshouses and, in the case of the
  violently mentally ill, imprisoned and punished
  as criminals.

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Introduction Continued

• The birth of psychiatry was the dominant force in
  defining insanity as a medical condition. The
  Association of Medical Superintendents of
  American Institutions for the Insane was formed
  in 1844 who began the publication of the American
  Journal of Psychiatry which reported remarkable
  success rates in psychiatric treatment of the
  mentally ill. This allowed the association to
  legitimize psychiatry as a medical specialty and
  to justify the exclusion of others without
  formal training in this specialty. Asylums or 
  psychiatric hospitals  became the primary
  response to mental illness and continued to
  increase in number until 1955 when the population
  of the hospitalized reached an all time high of
  558, 922 patients.

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Counseling v. Psychotherapy Divide

• It was largely in response to the US prejudice
  against lay therapists that Carl Rogers adopted
  the word 'counseling',
• Rogers was not originally permitted by the
  psychiatry profession to call himself a
  'psychotherapist'.
• In the field as it now stands, the argument as to
  whether counseling differs significantly from
  psychotherapy is largely academic.
• Others use 'psychotherapy' to refer to
  longer-term work and 'counseling' to refer to
  shorter term work
• The two terms are commonly used interchangeably
  in the US, with the obvious exception of
  'guidance counseling', which is often provided in
  educational settings and focuses on career and
  social issues.

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Counseling v. Psychotherapy Cont.

• Rejecting the notion of hidden aspects of the
  psyche which cannot be examined empirically,
  practitioners in the behavioral tradition began
  to focus on what could actually be observed in
  the outside world.
• Finally, under the influence of Adler and Rank, a
  'third way' was pioneered by the US psychologist
  Carl Rogers. Originally called 'client-centred'
  and later 'person-centred', Rogers's approach
  focuses on the experience of the person, neither
  adopting elaborate and empirically untestable
  theoretical constructs of the type common in
  psychodynamic traditions, nor neglecting the
  internal world of the client in the way of early
  behaviorists. Other approaches also developed
  under what came to be called the 'humanistic'
  branch of psychotherapy, including Gestalt
  therapy and the psychodrama of J.L. Moreno.

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Mary Richmond (1861-1928)

• The first professional Social Work person and
  brought about indirect and direct practice and
  she was the one who conceived the idea of
• PERON-IN-ENVIRONMENT!
• Richmond believed that the environment had a
  bigger part of what was wrong with a person than
  anything else.

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Lightner Witmer (1867-1956)

• Regarded as the inventor of the term "Clinical
  Psychology.
• Co-founder of the world's first Psychological
  Clinic in 1896 at the University of Pennsylvania.

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Granville Stanley Hall (1844-1924)

• Psychologist and educator who pioneered American
  psychology.
• Interests focused on childhood development and
  evolutionary theory.
• The first president of the American Psychological
  Association and the first president of Clark
  University.
• In 1887, he founded the American Journal of
  Psychology and in 1892 was appointed as the first
  president of the American Psychological
  Association, a position he held until his death.

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Gestalt Psychology

• Gestalt psychology is a theory of mind and brain
  that proposes that the operational principle of
  the brain is holistic, parallel, and analog, with
  self-organizing tendencies or, that the whole is
  greater than the sum of its parts.
• Although Max Wertheimer is credited as the
  founder of the movement, the concept of Gestalt
  was first introduced in contemporary philosophy
  and psychology by Christian von Ehrenfels.
• The whole is greater than the sum of its parts.

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Psychosocial Development Theory

• Erik Erikson (1902 1994) was a German
  developmental psychologist and psychoanalyst
  known best for his theory on social development
  of human beings. Erik Erikson also coined the
  phrase identity crisis.
• Psychosocial development as expressed by Erik
  Erikson describes eight stages of development
  through which developing humans should pass from
  infancy to late adulthood. In each stage the
  person confronts, and expectantly masters, new
  challenges. Each stage builds on the successful
  completion of earlier stages. Stages not
  successfully completed may reappear as problems
  in the future.

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Life Stages

• Infancy (Birth - 18 months) Trust v. Mistrust
• Post Infancy (18 months 3 years)
• Autonomy v. Shame and Doubt
• Preschool (3 6 years) Initiative v. Guilt
• School (6-12 years) Industry v. Inferiority
• Adolescents (12 20 years) Identity v. Role
  Confusion
• Early Adulthood (20 34 years) Intimacy v.
  Isolation
• Middle Adulthood (35 65 years)
• Generativity v. Stagnation
• Late Adulthood (65 years) Integrity v. Despair

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Historic Overview

• Modern psychological therapies trace their
  history back to the work of Sigmund Freud in
  Vienna in the 1880s.

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Psychoanalytic/Psychodynamic Theory

• Sigmund Freud (1856-1939) was commonly referred
  to as The Father of Psychoanalysis.
• Freud has been influential in two significant
  ways. He simultaneously developed a theory about
  how the human mind is organized and operates
  internally, and how human behavior conditions and
  results particular theoretical understanding.

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Psychoanalytic/Psychodynamic Theory

• Psychodynamics is the study of human behavior
  from the point of view of motivation and drives,
  depending largely on the functional significance
  of emotion, and based on the assumption that an
  individual's total personality and reactions at
  any given time are the product of the interaction
  between their conscious/unconscious mind, genetic
  constitution and their environment.

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Structural categories

• Level of consciousness
• Includes 3 levels of thought
• 1. Unconscious
• 2. Conscious
• 3. Preconscious

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Structures of Mind

• Include 3 personality structures
• Id
• Ego
• Superego

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Behaviorism/Learning Theory

• Ivan Pavlov conducted research on classical
  conditioning Edward Thorndike, John Watson, and
  B.F. Skinner conducted research on operant
  conditioning were the most influential to this
  theory.
• Behaviorism is concerned with apparent behavior.
  A behavior is a fact and thus a point of
  departure for attempting to explain it. The
  determinants are to be found in the external
  situation of the person, not in the persons
  inner life. The individuals personality is the
  sum of acquired behaviors and learned
  behavioral-environment relations.

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5 fundamental assumptions to this line of
Theoretical Development

• There is continuity of the species. Functional
  relationships between animal behavior and the
  environment also hold true for human beings.
• The conditions of environment are the principle
  determinants of both animal and human behavior.
• The procedures of natural science are the best
  way to understand behavior-environment
  relationships.
• Both normal and abnormal behaviors are the
  product of behavior-environment relationships and
  can be modified by the manipulation of these
  relationships.
• The individuals personality is the sum of
  acquired behaviors and learned behavioral-environm
  ent relations

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B. F. Skinner (1904-1990)

• His focus in operant conditioning is on the
  response and its consequences, not the antecedent
  stimulus. Behavior is determined by its
  consequences and the behavior precedes the
  stimulus.

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Albert Bandura 1925 - present

• Bandura was initially influenced by Robert Sears'
  work on familial antecedents of social behavior
  and identity learning.
• Directed his initial research to the role of
  social modeling in human motivation, thought, and
  action.
• In collaboration with Richard Walters, his first
  doctoral student, Bandura engaged in studies of
  social learning and aggression. Their joint
  efforts illustrated the critical role of modeling
  in human behavior and led to a program of
  research into the determinants and mechanisms of
  observational learning.

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http//www.youtube.com/watch?vpDtBz_1dkuk
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Bandura Cont

• Shaping As used in operant conditioning, is a
  method for establishing new behaviors. Shaping
  helps illustrate that conditioning typically
  occurs through a gradual process rather than all
  at once. A desired behavior can be achieved
  though a series of steps, with each step
  representing progress toward achievement of the
  sought after behavior.

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Aaron Beck (1921-present)

• The cognitive model especially emphasized in
  Aaron Beck's cognitive therapy says that a
  person's core beliefs (often formed in childhood)
  contribute to 'automatic thoughts' that pop up in
  every day life in response to situations.
• Cognitive Therapy practitioners hold that
  clinical depression is typically associated with
  negatively biased thinking and irrational
  thoughts.

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Cognitive-Behavioral Theory

• CBT is commonly based on the idea that how we
  think (cognition), how we feel (emotion), and how
  we act (behavior) are all entwined and acting
  together. This states that our thoughts influence
  our feelings and behavior, our feelings influence
  our behavior and thoughts, and our behaviors
  influence our emotions and thoughts.

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Rational Emotive Behavior Therapy

• Rational Emotive Behavior Therapy (REBT) is a
  comprehensive, active-directive, philosophically
  and empirically based psychotherapy which focuses
  on resolving cognitive, emotional and behavioral
  problems.
• REBT was created and developed by the American
  psychotherapist and psychologist Albert Ellis
  (1913-2007). REBT is one of the first forms of
  Cognitive Behavior Therapy (CBT), first expounded
  by Ellis in the mid-1950s.
• The fundamental premise of REBT is that people to
  a large degree disturb, upset and defeat
  themselves through how they construct their view
  of reality by the means of their evaluations,
  beliefs and philosophies about negative events in
  addition to the events themselves.

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Cognitive Development Theory

• Jean Piaget (18961980) Provided many central
  concepts in the field of developmental psychology
  and concerned the growth of intelligence. The
  theory concerns the emergence and acquisition of
  schemes in "developmental stages", times when
  children are acquiring new ways of mentally
  representing information.
• The theory is considered "constructivist",
  meaning that it asserts that we construct our
  cognitive abilities through self-motivated action
  in the world.
• For his development of the theory, Piaget was
  awarded the Erasmus Prize.

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4 Main Periods

• Piaget divided schemes that children use to
  understand the world through four main periods,
  roughly correlated with and becoming increasingly
  sophisticated with age
• Sensorimotor period (years 02)
• Preoperational period (years 27)
• Concrete operational period (years 711)
• Formal operational period (years 11adulthood)

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Humanism Theory

• Humanistic psychology is a school of psychology
  that emerged in the 1950s in reaction to both
  behaviorism and psychoanalysis.
• The position of the Humanist is that a person has
  the capacity for self-awareness that he does
  have control over his behavior. The Humanist
  allows that a person has freedom of choice,
  self-determination and is responsible for his
  self-direction.

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Abraham Maslow (1908-1970)

• Among the earliest approaches we find the
  developmental theory of Abraham Maslow,
  emphasizing a hierarchy of needs and motivations.

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Maslows Hierarchy of Needs
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Postmodern Theories

• Postmodern psychology says that the experience of
  reality is a subjective construction built upon
  language, social context, and history, with no
  essential truths. Since "mental illness" and
  "mental health" are not recognized as objective,
  definable realities, the postmodern psychologist
  instead views the goal of therapy strictly as
  something constructed by the client and
  therapist.

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Examples of Postmodern Theories

• Strength Based Therapy
• Narrative Therapy
• Feminism

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Postmodern Therapy

• Forms of postmodern psychotherapy include
  Narrative Therapy, Strength Based Therapy, and
  Coherence Therapy.
• Solution Focused Therapy (SFT) is a type of
  talking therapy that is based upon social
  constructionist philosophy.

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Strength Based Therapy

• Focuses on what clients want to achieve through
  therapy rather than on the problem(s) that made
  them seek help.
• Focus is on the present and future.
• The therapist/counselor uses respectful curiosity
  to invite the client to envision their preferred
  future and then therapist and client start
  attending to any moves towards it whether these
  are small increments or large changes.
• To support this, questions are asked about the
  clients story, strengths and resources, and
  about exceptions to the problem.

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Examples of Strength Based Questions

• The miracle question
• Scaling Questions
• Exception seeking Questions
• Coping Questions
• Resources

35
Narrative Therapy

• Narrative therapy holds that our identities are
  shaped by the accounts of our lives found in our
  stories or narratives.
• A narrative therapist is interested in helping
  others fully describe their rich stories and
  trajectories, modes of living and possibilities
  associated with them.
• By focusing on problems' effects on people's
  lives rather than on problems as inside or part
  of people, distance is created. This
  externalization or objectification of a problem
  makes it easier to investigate and evaluate the
  problem's influences.
• Another sort of externalization is likewise
  possible when people reflect upon and connect
  with their intentions, values, hopes, and
  commitments.
• Once values and hopes have been located in
  specific life events, they help to re-author or
  re-story a person's experience and clearly
  stand as acts of resistance to problems

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Feminism

• Feminism is an ideology focusing on equality of
  the sexes. Feminism comprises a number of social,
  cultural and political movements, theories and
  moral philosophies concerned with gender
  inequalities and discrimination against women.
• Some feminists, such as Simone de Beauvoir and
  Judith Butler, have argued that gendered and
  sexed identities, such as "man" and "woman", are
  social constructs.

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Insurance Coverage

• The Paul Wellstone Mental Health and Addiction
  Equity Act is legislation that would end the
  practice of insurance companies discriminating
  against people suffering from mental illness. 
  Sponsored by Representative Patrick Kennedy
  (D-RI) and Wellstone's friend Representative Jim
  Ramstad (R-MN), the bill would compel insurance
  companies to treat mental illness the same as
  physical illness, given the overwhelming
  scientific evidence that mental illness is a
  disease every bit as real and serious as physical
  illness.  This practice is often referred to as
  "mental health parity."

38
Insurance Coverage Continued

• The Mental Health Parity Act was signed on
  September 26, 1996. This Act required that
  annual or lifetime dollar limits on mental health
  benefits equaled those of surgical benefits.
  This applies to group health plans for plan years
  beginning on or after January 1, 1998. The
  current extension runs through December 31, 2007.
• This act does not apply to benefits for substance
  abuse or chemical dependency.
• This act allowed insurance companies to cover the
  cost of mental health services and that insurance
  companies ensure all plans provide mental health
  coverage to some minimal degree.

39
Insurance Coverage Continued

• The Mandated Insurance Benefits Law, WI Statute
  632.89, was developed in 1973 as a way of
  handling reimbursement and overseeing
  professionals who were not licensed. This law was
  progressive in its time as it advocated mental
  health parity by requiring insurance companies to
  provide a minimum amount of first dollar coverage
  for mental health - both inpatient and
  outpatient however, this law is outdated.
• Clinical social workers obtained licensure in
  2002. They are regulated by the Wisconsin
  Department of Regulation and Licensing and have
  the right to practice psychotherapy
  independently.

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How Psychological aspects are used in Social Work

• Psychological Theories are used in the practice
  of Social Work.
• These are integrated in the assessment, planning,
  intervention, and evaluation stages of the
  Generalist Intervention Model (GIM).

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General Systems Theory

• Proposed in 1936 by biologist Ludwig von
  Bertanlanffy and further developed by Ross Ashby.
• He emphasized that real systems are open to, and
  interact w/ their environments, and that they can
  acquire qualitatively new properties thru
  emergence, resulting in continual evolution.
• Rather than reducing an entity to the properties
  of its parts, systems theory focuses on the
  arrangement of and relations between the parts
  which connect them into a whole. This particular
  organization determines a system, which is
  independent of the concrete substance of the
  elements.

42
General Systems Theory Continued

• General systems theory is based on the assumption
  that there are universal principles of
  organization, which hold for all systems, be they
  physical, chemical, biological, mental or social.
  
• Systems concepts include system-environment
  boundary, input, output, process, state
  (homeostasis or dynamic entropy), hierarchy,
  goal-directedness, and information.
• The systemic world view, contrary to the
  mechanistic view, seeks universality by ignoring
  the concrete material out of which systems are
  made, so that their abstract organization comes
  into focus

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Generalist Intervention Model

• Engagement
• Assessment
• Goals
• Planning
• Intervention
• Evaluation
• Termination
• Follow Up

44
Analytic vs. Systemic Approaches

• The analytic approach seeks to reduce a system to
  its basic elements in order to study in detail.

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References

• Chess, Wayne A. Dale, Orren. Norlin, Julia M.
  Smith, Rebeca. Human Behavior and the Social
  Environment Social Systems Theory. 5th ed
  Pearson Education. 2006.
• F. Heylighen (2000) "Analytic vs. Systemic
  Approaches", in F. Heylighen, C. Joslyn and V.
  Turchin (editors) Principia Cybernetica Web
  (Principia Cybernetica, Brussels). Retrieved
  October 29, 2007, from http//cleamc11.vub.ac.be/
  REFERPCP.html.
• Liska, A.E. (1992). Social Threat and Social
  Control. Albany State University of New York.
• Woods, M.E., Hollis, F. (2000). Casework A
  Psychosocial  Therapy (5th ed.). Boston
  McGraw-Hill.
• York University IS Research. (2007). Theories
  used in IS research. Retrieved October 29, 2007,
  from http//www.istheory.yorku.ca/generalsystemst
  heory.htm