Sunday, December 21, 2008

Bipolar I, II, and Cyclothymic Disorder

A friend and I were having this discussion about the differences between Bipolar I and II, and I had to revert to my trusty pocket version of the DSM to remind myself.

Bipolar I is the most extreme of the disorders. In order to receive a diagnosis of Bipolar I the individual must have at least one manic episode. MANIC is the key term here- HYPOMANIC is not the same.

Hypomania can have symptoms of rapid speaking, racing ideas, not sleeping, and surges of energy. Individuals who are hypomanic are usually able to keep up with their social and occupational obligations.

Mania is intense and often frightening. Individuals may lose touch with reality, believing they are a deity, on a mission from a deity (delusions of grandeur), or experience a psychotic break. They may fly into rages. They may engage in dangerous and destructive behaviors such as abusing stimulants (cocaine, speed) or reckless driving. They may spend money with abandon and may ruin their financial lives in a matter of days.

A mixed episode is when mania and the depressive state are happening at the same time. Just thinking about this occurring is a nightmare for me. Visualize a person in a very foul, depressed, hopeless mood and combine it with racing thoughts and raging energy. Mixed episodes have symptoms such as panic, paranoid delusions, suicidal ideation, and rage.

Ok, so back to Bipolar I and II.

Bipolar I must have had at least one manic episode. A depressive episode is not needed for the diagnosis, but will usually be present at least once.

Bipolar II must have had at least one hypomanic episode and one depressive episode.

Cyclothymia could be seen as Bipolar II Lite. There must be hypomanic episodes and depressive episodes, but the depressive episodes do not need to be as severe as they are for Bipolar II.

Wednesday, December 17, 2008

Anorexia and Bulimia

After taking the exam, realized there was quite a bit more about the DSM on the exam than I had anticipated. Therefore, I bring you another 'difference between' entry. The difference between Anorexia and Bulimia is a really sticky one. Sometimes you hear people say, 'I was anorexic and bulimic'. Well no, they were anorexic: purging type. Some people with anorexia will occasionally binge and purge, and some will eat small meals and purge. Both anorexia and bulimia have symptoms of abusing laxatives or diet pills, purging, and excessive exercising.

People with anorexia will always see themselves as fat no matter how thin they get. In order to get the diagnosis of anorexic, the person must refuse to maintain a healthy weight. Women will often stop menstruating.

People with bulimia tend to stay an average weight. They binge frequently and feel like once they start eating they are not able to stop.

In an oversimplified nutshell, remember that people with anorexia are irrationally convinced they are fat and are obsessed with being thin. People with bulimia are obsessed with food and purge/abuse pills/excercise to compensate for their binging. Anorexics are always underweight and bulimics are usually at an average weight.

Wednesday, December 10, 2008

I passed!

My exam was this morning, and I am pleased to report that I passed! It was 170 questions long and took me a little over 2 hours. A passing score in Indiana is a 75 and I scored an 86.

It was definately very nerve racking... I had dreams about it all night last night. Every time I fell back asleep I'd have another dream about it. I was terribly nervous when I started the exam, but you can't stay nervous through 170 questions (well, maybe you can, but I can't). After about question 20 I got into a good groove. There were many questions that were obvious, some that would have been difficult had I not studied, and a handful where I was like, "WTF?" After I finished all the questions and went over the flagged ones I started to really get nervous again. I sucked it up, hit the 'quit' button and... AN EXIT SURVEY! What? Who would possibly take their time filling out an exit survey knowing it was the only thing between them and knowing if they passed? After the survey a page pops up that says "Examination results: PASS"


So, now that I have sat through that monster, I will depart some wisdom.

First, there are approximately 10,000 questions that end with, "what would you do first?" For example:
You work in a dialysis clinic. A client comes to you complaining that the bus does not pick him up and he has been missing his treatments. What would you do first?
A. Move the client to an assisted living facility.
B. Call his family and ask them to start driving him.
C. Help him hire a private driver.
D. Assist him in calling the bus service to complain.

So, these are potentially all viable options, depending on what the specifics of the scenario are. But the question is not asking you, 'what do you think would be the best option?', it's asking you what your very first step would be. And in this case, the very first step would be to help the client advocate for himself (ie, D). Why would you skip right to B when the bus people may have just accidentally dropped him off their list or didn't realize the life sustaining necessity of him being on time?

There are also multiple questions about boundaries and dual relationships. There's supposed to be a small percentage of 'ethics' questions, and at least on my test, ethics = boundaries and dual relationships. In case you just got on the social work boat, we're not allowed to be business partners with clients, provide therapy to our co-workers, etc.

Cultural competency: if I remember correctly, I had questions about Native American families, questions about working with Asian immigrants, and questions about working with Hispanics. Many of these questions just seemed to be about whether or not you were open minded enough to explore something further or if you would just freak out and call child services. (Note: the answer is not to freak out and call child services.)

Questions that you have absolutely no idea what the answer is: this happened to me several times. I would look at this question, read it four times, then think, 'what the hell... is this even social work? fhdfgkihd;'. Then I realized that while I didn't have a freaking clue what the answer was, I did recognize most of the answers. So the question would go something like this:
What modular battery is needed to launch a robotic jet pack?
A. Systems theory
B. Zoloft
C. Gestalt therapy
D. fission

Ok, so I never studied anything related to robotics. However, I did study systems theory and I don't recall it says anything about robots. Zoloft is a medicine and as far as I know does not double as an electronic energy source. Gestalt therapy... I'm pretty vague on that, but I think it involves talking to empty chairs. Fission... what the hell is fission? So I basically just match the WTF question to the WTF answer.

More revelations to come.

Friday, December 5, 2008

Metaframeworks and Family Therapy

I'm almost positive that nothing this complicated could possibly be on the test, but I wanted to make a note for anyone interested in family social work that there is a book I have used that will BLOW YOUR MIND. Seriously. I had an entire class on this book and I still can't get my head around it completely. It's called "Metaframeworks: Transcending the Models of Family Therapy" by Breulin, Schawartz, and Kune-Karrer. The book opens with a chapter on reality. Is there an unquestionable reality? Is reality subjective? Is reality something that doesn't exist at all? And if any of these are true, what does it mean for therapy?

It then progresses to break family dynamics and behavior down into hard science. Charts, graphs, sequences... it's like reading a biology book. They make arguments that there are four overarching patterns in our lives that all occur at different times and last different lengths of time. They range from face to face short occurrences (Class 1) to intergenerational patterns that transcend decades (class 4). All four patterns are related.

My favorite chapter is on gender. The authors point out five "gender evolution positions". In the first, traditional, "women may experience some oppressed and angry parts." (p. 250). (I should mention here that 'parts' of people are HUGE in this book. Angry parts, sad parts, abandoned parts, child parts... it's awesome.) The polarized part of the evolution has very angry women parts and very defensive and guilty man parts. The gender evolution isn't what is so awesome about this chapter. The awesome part is the discussion on how gender affects therapy. If the stage of gender evolution is seemingly causing problems, or if gender is part of a maladaptive sequence (pattern), how does a therapist begin to challenge the way gender is expressed in a family? How does culture affect gender patterns, and should culture be challenged if it is part of a distressful pattern? Strategies to move families through the next stage of the evolution are included.

Now, this short blurb is not displaying the true awesomeness that it is. I can't describe it well because I have a hard time understanding it myself. But you you're into family therapy and really stretching your brain, seriously, get this book. It's not an expensive textbook. I think I bought it for $12.

Generalist Intervention Model

When one thinks about intervention models, the firs thing that usually comes to mind is crisis intervention. What I'm going to be addressing here is a general overview of what any standard intervention should look like.

Step 1: Get an overview of the client/s situation. What is the client/s point of view of the problem? What do they believe is causing the problem? What possible solutions have been tried? How did they work? Think of this as information gathering.

Step 2: Assessment. Develop a possible hypothesis. What is making the situation worse? What systems are involved here? How are external and internal forces acting on the situation? This is not set in stone and may change as more information is presented. Assessment is key to intervention, so this should be done very carefully and thoroughly, and updated necessary. Good assessments are culturally competent.

Step 3: Come to a consensus with client on what needs to happen. What goals should be accomplished to work towards resolving the issue?

Step 4: Agree with the client on the client's role and your role in the intervention.

Step 5: Proceed with the intervention! (Example interventions, agreed on in step #3, could be drug and alcohol counseling, finding and applying for subsidized daycare, attending vocational training, etc.)

Step 6: Evaluate! Always evaluate! Evaluation is both for the client and yourself. After the intervention is over you want to know if it had lasting results.

Adapted from:
Ambrosino, R., Heffernan, J., Shuttlesworth, G., & Amrosino, R. (2001). Social work and social welfare: An introduction (4th ed.) Belmont: Brooks/Cole.

Thursday, December 4, 2008

Group Work - The Personalities

Groups are known for those very distinctive personalities. I believe it's safe to say that we all recognize these particular gems. Strategies for dealing with these individuals follows.

The member who always speak first, AKA The Excessive Talker (ET)
To encourage someone else to speak first, use your eye contact. Start with eye contact with the excessive talker, and sweep around and end the question with the ET completely out of your field of vision. This isn't guaranteed to work, but when the ET is not in your field of sight at all, it will appear you're not posing the question to them. Begin looking at them to avoid appearing rude.

The member who tells the same stories or shares the same problems over and over, AKA The Broken Record
Disengage eye contact and hope for the ‘wind down’. When the member lacks eye contact they usually realize it's time to move on. If this happens so much it's disruptive or the eye contact isn't working, scan the group. If everyone has checked out it’s time to be frank. "Cara, have you noticed that our attention is waning? This is probably because we’ve heard this story before. What can we do to help you?"

The Quiet Member
It's best to draw out quiet members as soon as possible, sometimes even in the first session. The longer a member waits to participate the harder it will become. If they seem to be agreeing quietly or deep in thought, the following are appropriate ways to gently prompt participation:
"Donna, you seem to be agreeing with what Will said. Would you like to tell us a little about what you’re thinking?”
“Caleb, you look like you’re thinking about something. Would you share with us?”
You can also pose a general question while looking directly at the member. The member can chose to accept the eye contact as an invitation to speak, or ignore it. Although it is awkward to ignore a question that appears to be posed directly at you even if it is phrased as a question for everyone.
Dyads are also helpful because when two people pair up to speak, it's usually impossible for the member to not speak with their partner. This also helps the shy member meet other members and feel more comfortable.

Adapted (very loosely) from:
Jacobs, E., Masson, R., & Harvill, R. Group counseling strategies and skills. (5th ed.) Belmont: Thomson.

Tuesday, December 2, 2008

Group Work

The following are types of groups and a brief description of them.

Education Group
In an education group, the facilitator's main goal is to provide information. Some discussion is appropriate. Examples include youth learning study skills and dialysis patients learning about transplant.

Discussion Group
In a discussion group, the participants discuss topics and not their personal issues. The facilitator is just the person in charge and not necessarily an expert. An example would be a book club.

Task Group
A task group is a group that forms in order to accomplish a task. When the task is completed, the group is dissolved. Examples include students working on a group project, or a committee planning an event.

Growth or Experiential Groups
This type of group's task is to grow as individuals. Examples include spiritual encounter retreats, and physical challenge retreats.

Counseling Groups
Counseling groups are typically for individuals who are experiencing life challenges such as divorce, making friends, life changes, etc. The facilitator may guide the group on topics and tease out details of an individuals situation. The group members are encouraged to help each other.

Therapy Groups
Therapy groups are typically for individuals with problems that are more severe than those in counseling groups. There are many techniques for group therapy and they may look radically different from each other. Examples include groups for women who have been assaulted, individuals in residential addiction rehabilitation, and people with anxiety.

Support Groups
A support group is a group where the members have something in common and meet regularly to support each other. Support groups allow members to realize there are people with the same struggles they have. Members should talk to each other and the facilitator role should be minimal. Examples include groups for people living with a specific illness, parents who have lost children, or people who experienced a common event (such a school shooting).

Self Help Groups
Self help groups do not have social workers are their leaders; they are lead by one of the participants. They typically follow the AA model.

Adapted from:
Jacobs, E., Masson, R., & Harvill, R. Group counseling strategies and skills (5th ed.) Belmont: Thomson.