UNIVERSITY OF SOUTHERN CALIFORNIA __SW 645



UNIVERSITY OF SOUTHERN CALIFORNIA

SCHOOL OF SOCIAL WORK

SAN DIEGO ACADEMIC CENTER

SOWK 645

Sections 60883 and 60465

CLINICAL PRACTICE IN MENTAL HEALTH SETTINGS:

ADULT OUTPATIENT SECTION

3 Units

FALL 2011

Instructor: Sharon Wheeler, LCSW

E-mail: smwheele@usc.edu

Office: SDAC

Office Hours: Tuesdays 11:00-12:00 and by appointment

I. CATALOGUE DESCRIPTION

Social work processes from intake to termination, emphasis on clinical skills required for social work practice in a broad spectrum of mental health settings. Required for students in Mental Health concentration.

II. COURSE DESCRIPTION

This third level practice course, Clinical Practice in Mental Health Settings, builds on previous practice courses in a number of ways. Previous knowledge and skill regarding life cycle issues and developmental theory will be applied to practice with mental health service populations. Generic practice skills in working with individuals and their support systems, carried through from the first year, will have a new application specifically to mental health services clients. Core concepts of relationship, the therapeutic alliance, problem solving, and the phases of treatment are applied to common mental health disorders. Within a bio-psycho-social, ecosystemic framework, specific interventions with varying theoretical bases are examined for appropriate treatment of disorders. These include psychodynamic treatment (particularly self psychology, object relations and the relational school, ego psychology, attachment-based interventions), cognitive and behavioral treatment, and the expressive therapies. Evidence-based and empirically-based treatments will be addressed.

The student's introductory skills obtained in the first year, regarding work with clients experiencing common presenting problems, will be advanced. Students will learn how to treat clients from diverse groups often seen in urban mental health settings, including those persons evidencing anxiety disorders, trauma related disorders, depression, phobia, eating disorders, psychoses, and personality disorders.

Further, the construct of the continuum of care will be applied to intervention with these populations with emphasis on the outpatient experience for adults. The course opens with a unit on prevention and we will then examine treatment from outpatient to inpatient care, after care, including case management and managed care issues. The impact of social injustice on those seeking mental health services, and the effects of stigma will be examined throughout this course as these issues apply to clinical practice. Further, building on first year content, we will address practice implications of work with culturally diverse, client groups with respect to race, ethnicity, class, gender, sexual orientation, religion, and age, as they apply to issues in clinical practice. We will also discuss how the complex, urban experience of mental health service differs from other regions of the country and what you will need to know for clinical practice in this environment. This year, content will be applied to work in mental health settings. Knowledge of legal and ethical considerations, and the value -base of social work practice will be advanced and applied directly to work in mental health settings. Throughout the course, we will discuss the effects of working with highly distressed clients on the worker, and the value base of service providers.

III. COURSE OBJECTIVES

Within these parameters, objectives are to enable the student to:

1. Use knowledge of explanatory theories of human behavior to enhance skill in accurate assessment of mental health clients coping with their often complex social situations, particularly in multicultural, urban environments including:

a. Psychosocial implications of mental illness, or handicapping mental or emotional conditions on clients and their support systems.

b. Psychosocial development and personality functioning of the client and support systems.

c. Client use of mental health care, reasons why and why not.

d. Influence of race, ethnicity, social class, gender, age, and religion on individuals and their support systems.

e. Familiarity with social work values and ethics pertaining to the use and misuse of the DSM IV diagnostic entities, particularly with reference to issues of culture, gender, class, race, age, religion, and physical ability.

2. Extend and deepen knowledge and demonstrate skill in treatment planning (informed by research findings) with mental health clients and their support systems living in Southern California, a global community with complex, multicultural influences.

3. Deepen understanding of the use of the worker/client relationship and the working alliance with individuals and their support systems from a variety of cultures, classes, race, and ages.

a. Understand one's own feelings, values, experiences, and culture as these enhance or detract from helping relationships with clients, colleagues, and others.

b. Understand the feelings, values, experiences, and culture of the individual client and their significant others as these influence positive motivation or resistance in the treatment relationship.

4. Apply various practice theories (building on first year content) toward developing competence in intervening in beginning, middle, and ending phases of treatment.

a. Gain knowledge of interventions that have been supported by research

as being effective with mental health problems.

  b. Understand the strengths and limitations of empirically supported

interventions in working with culturally diverse groups of people with mental health problems.

c. Understand the process of evidence based practice and its application

to mental health populations.

5. Develop competence in practice skills (informed by research findings) across the continuum of care for work with those presenting common mental health problems evidenced in clients living in multicultural, and complex, urban environments.

6. Demonstrate understanding of practice in urban, multicultural mental health settings, and the leadership role of the social worker in cooperative, and team activities.

a. Demonstrate identity as a social worker, with clarity about the social work domain, values, ethics, clinical privileges, and responsibilities.

7. Develop leadership skills by identifying and taking a position on philosophical and ethical dilemmas and legal issues confronting self, client groups, and staff in the mental health care system.

IV. COURSE FORMAT / INSTRUCTIONAL METHODS

A combination of lecture, media, and experiential format will be utilized in this class in order to highlight process and to build skills in a variety of practice modalities. We will be discussing some readings through reading groups. Simulated interviews, case examples, dvds, films, and structured class exercises will accompany lectures and assigned readings. Students will have an opportunity to consult with the professor and the class on particular cases held in the field through experiential exercises and class discussion. Confidentiality is always observed.

V. Course Assignments, Due Dates & Grading

|Assignment |Due Date |% of |

| | |Final Grade |

| | | |

|Research Paper or Presentation |Oct. 4 |45% |

| | | |

|Reflective Journal |Nov. 29 |35% |

| | | |

|Reading Cards |Each week |10% |

|Class Participation |Each week |10% |

Research Paper or Presentation 45% of grade (Covers all Objectives)

This assignment is a library research paper or major class presentation with documentation in which you will examine a particular mental health problem, or vulnerable population. If you prefer to complete this assignment as a class presentation, with documentation, you will need to plan this with me on or before class session 4. Examine intervention strategies for the identified mental health problem including referral, engagement, assessment and diagnosis, contracting, core phase (including the use of relationship and expressions of resistance), termination, aftercare, and evaluation of practice, using one or more practice theories. Discuss the role of a social work clinician and how this role is distinguished from other service providers, including the responsibility of leadership. Include issues of the working alliance, transference and countertransference as they may apply to treatment. Include material throughout on diversity, ethics and values, and issues of social justice. Use APA writing format with Times New Roman font. The paper should be 15 to 20 pages in length. See detailed guidelines at end of this syllabus.

Reflective Journal 35% of grade. (Objectives 1, 3, 4, 6a)

Select a book from the literature list at the end of the syllabus and reflect on this book from your perspective as a social work student in the field of mental health. This is an integrative assignment and should be 8 to10 double-spaced typewritten pages in APA format.

1. Discuss your impressions of the book holistically. Identify and assess mental health issues that appear or flow throughout the book. Present how you might address these issues as a mental health social work practitioner working with this client system, using principles, strategies, and treatments covered in the course.

2. Give your thoughts/feelings during the semester regarding cases you hold in the field, and news-worthy events as they relate to the book you select.

3. Discuss in some detail how the work AFFECTS YOU AS A CLINICIAN AND AS A PERSON.

Reading Cards 10%, Objective 4. Due each week in class. On a 3 x 5 card summarize key ideas and your critical comments from each required reading.

Class Participation 10%, Objectives 6a and 7

Attendance and participation are expectations of this class. Evaluation of class participation includes quality of participation, including active listening and engagement, discussion, on time attendance, and quality of involvement in experiential exercises. This requires that you come to class prepared to discuss readings and their application to practice. Please notify me of any absence.

Guidelines for Evaluating Class Participation:

10%, Outstanding Contributor: Contributions in class reflect exceptional preparation and critical examination. Ideas or questions offered are substantive, provide one or more major insights, as well as direction for the class. Application to cases is succinct and on target. Challenges are well substantiated, persuasively presented, and presented with excellent comportment. If this person were not a member of the class, the quality of discussion would be diminished markedly. Exemplary participation in experiential exercises demonstrating on target behaviors in role plays, small group discussions, and other activities.

8% - 9%, Good Contributor: Contributions in class reflect good preparation. Ideas and questions offered are usually substantive, provide good insights and sometimes direction for the class. Frequent application to cases held is usually on target and on topic. Challenges are well substantiated, often persuasive, and presented with excellent organization. If this person were not a member of the class, the quality of discussion would be diminished. Good activity in experiential exercises demonstrating behavior that is usually on target in role plays, small group discussions, and other activities.

5% -7%, Adequate Contributor: Contributions in class reflect adequate preparation. Ideas and questions offered are often substantive, provides generally useful insights but seldom offer a new direction for the discussion. Sometimes provides application of class material to cases held. Challenges are sometimes presented, fairly well substantiated and informed, and are often persuasive. If this person were not a member of the class, the quality of discussion would be diminished somewhat. Participation in experiential exercises often demonstrates good understanding of methods in role plays, small group discussions, and other activities.

0% - 4%, Inadequate Contributor: Rarely or never offers comments or questions in class. Provides little or no basis for evaluating preparation for class. Participation in exercises, small group discussions, and other activities rarely demonstrates critical understanding or integration of the material. If not a member of the class, the quality of discussion would not change.

A note on lap top computers and phone texting.

Recently, there have been instances of phone texting, checking email, cruising the net, and playing computer games during class. As a graduate class, we, students and instructor, are mutually responsible for creating our classroom learning environment. Thus, use of one’s personal laptop computer should be restricted to taking notes during lectures. Cell phones should be turned off. Any exceptions, such as being on call for work or ill family members at home, should be cleared with the instructor. Abuse of laptop or phone use during class will result in a reduction of the participation grade. Repeated occurrence may reduce one’s semester grade by as much as 10%.

VI. Readings

With the exception of required textbooks, readings (primarily articles) are available on ARES and on the internet. While some readings are current and cutting edge, others are older classics in the profession. Everyone should complete core readings as identified in the syllabus or in class. Reading groups or pairs will be assigned selected required readings to report on in class for most weeks during the semester. Additionally, optional readings are identified for each general topic in the course schedule. You may elect to complete any of these following the required readings. Non-required readings are excellent resources for gaining deeper knowledge or a broader perspective on specific areas of interest.

Required Texts

Austrian, S. (2000). Mental Disorders, Medication and Clinical Social Work, 2nd edition. New York: Columbia University Press.

Badenoch, B. (2008). Being a Brain-wise Therapist. New York: W.W. Norton.

Brisch, K. (2002). Treating attachment disorders from theory to therapy. NY:

Guilford.

Goldstein, E. (2001). Object Relations Theory and Self Psychology in Social

Work Practice. NY: Free Press. NY: WW Norton.

Zimmerman, M. Interview Guide for evaluating DSM IV Psychiatric Disorders. and the Mental Status Exam. Phila. PA: Psych. Products Press.

Recommended Texts: Readings are also assigned in these books.

Gaw, A. Culture, Ethnicity, and Mental Health. APA. Press.

Morrison, J. (1995- or latest edition). The DSM IV Made Easy: The Clinician’s

Guide to Diagnosis. New York, Guilford.

Solomon, M. & Seigel, D. (2003). Healing Trauma: attachment, mind, body &

brain. (optional)

VII. School of Social Work Grading Policy

Within the School of Social work, grades are determined in each class on standards established by the school as follows. 1) Grades of A or A- are reserved for student work which not only demonstrates very good mastery of content but also shows that the student has undertaken a complex task, has applied critical thinking skills to the assignment, and or has demonstrated creativity in the approach to the assignment. The difference between these two grades is determined by the degree to which these skills have been demonstrated. 2) A grade of B+ will be assigned to work which is judged to be very good. This grade reflects a more-than-competent performance on the assignment and understanding of the material. 3) A grade of B will be assigned to work which meets the basic requirements of the assignment. It denotes adequate work on the assignment and meeting basic course expectations. 4) A grade of B- denotes that performance was less than adequate on the assignment, reflecting only moderate grasp of content or expectations. 5) A grade of C reflects minimal grasp of the assignment and organization of ideas, and/or several significant areas requiring improvement. 6) Grades between C- and F denote failure to meet even minimum standards, reflecting serious deficiencies in all aspects of performance on the assignment.

VIII. School of Social Work Attendance Policy

Students are expected to attend every class and to remain in class for the duration of the session.  Failure to attend class or arriving late may impact your ability to achieve course objectives which could affect your course grade.  Students are expected to notify the instructor by telephone or email of any anticipated absence or reason for tardiness.

University of Southern California policy permits students to be excused from class, without penalty, for the observance of religious holy days. This policy also covers scheduled final examinations which conflict with students’ observance of a holy day. Students must make arrangements in advance to complete work which will be missed, or to reschedule an examination, due to holy days observance.

COURSE SCHEDULE

Unit I - Session 1: Introduction: Prevention of Mental Disorders

objectives 1a,1c,1,d,1e, 5,7

A. The Continuum of Care: concepts, educative and preventive techniques

B. Primary prevention versus secondary and tertiary models

C. Anticipatory intervention and situational stress, stress reactions and

treatment review

D. Prevention practice skills with individuals and their support systems

E. Issues of diversity and social injustice in mental health treatment in Los Angeles: who gains access to help, where, when, and how. Ethics & values in S.W.

Required Reading

Read the entire course outline.

Hodges, D. (2004). Working with Hindu Clients in a spiritually sensitive manner. Social Work, 49, 1, 27-38.

Lau, A. (2000). Examining the effects of ethnic-specific services: An analysis of cost-utilization and treatment outcome for Asian Americans. J. of Community Psychology, 28,1, 63-77.

Morris, E. (2002). Clinical practices with African Americans: Juxtaposition of standard clinical practices and Africentricism. Professional Psychology, 32,6, 563-572.

Rogler, L. (1993). Culturally sensitizing psychiatric diagnosis. Journal of Nervous and Mental Disease, 181,7, 401-408.

Simons, R. Culture Bound Syndromes. In A. Gaw (ed.). (1993). Culture, Ethnicity, and Mental Illness. Washington, D.C.: APA Press, 75-94.

Lasser, R., Himmelstein, D., et al. (2002). Do Minorities in the United States Receive Fewer Mental Health Services Than White? International Journal of Health Services, 32, 3, 567-578.

Neighbors, H., Caldwell, C., et al. (2007). Race, Ethnicity, and the Use of Services for Mental Disorders. Arch Gen Psychiatry, 64, 485-494.

Cuijpers, P., Van Straten, A., et al. (2005). Preventing the Incidence of New Cases of Mental Disorders. Journal of Nervous and Mental Disease, 193, 2, 119-125.

Vega, W., Karno, M., et al. (2007). Research Issues for Improving Treatment of U.S. Hispanics With Persistent Mental Disorders. Psychiatric Services, 58, 3, 385-394.

Hwang, W.C. (2006). The Psychotherapy Adaptation and Modification Frame: Application to Asian Americans. American Psychologist, 61, 7, 702-715.

Further Readings (not required)

Weaver, J. (1995). Disasters: Mental health interventions. Sarasota, FLA: Professional Resource Press.

Unit II - Clinical Practice with Adult Individuals: Implementation of DSM IV skills; assessment, and evidence-based and empirically supported treatment interventions. This unit covers all objectives.

Session 2 & 3:

Treating Anxiety and Phobia; Compulsive, and Somataform Disorders: Use of Supportive treatment, systematic desensitization/ behavioral interventions, mindfulness meditation

A. Differential manifestation of anxiety and phobia across cultural & gender lines, issues in practice, the mental status examination

B. Assessment of anxiety in differing disorders, diagnosis of anxiety states, a review

1) Cultural implications of assessing and treating anxiety (the L.A. example)

C. Treatment planning and interventions for clients with anxiety disorders, psychophysiologically involvement, and individuals with obsessive-compulsive disorders; use and abuse of DSM IV, Best practice models. Cognitive Behavioral Treatment, Systematic desensitization, Supportive treatment, Crisis Intervention, a review, Self Psychology.

D. The continuum of care; outpatient care

E. Effects on the worker and countertransference issues

Required Reading for Session 2:

Austrian, S. (2004). Mental Disorders, Medications and Clinical Social Work. New York: Columbia University Press. Ch. 2. Anxiety Disorders. pp. 11-32.

Austrian, S. (2004). Mental disorders, medications and clinical social work. New York: Columbia University Press.Ch. 4, Somatoform & fictitious disorders, 60-73.

Badenoch, B. (2008). Ch. 3 The brain’s flow. In Being a brainwise therapist. 23-41; Ch 4. The relationship between brain and mind. 42-75.

Baez, A. (2001). Complementary spiritual beliefs in the Latino community: The interface with psychotherapy. American J. of Orthopsychiatry, 71,4, 408-415.

Brisch, K. (2002) Attachment disorders in adults, panic and agorophobia. In Treating attachment Disorders. NY, Guilford, 198-207.

Goldstein (2001). Ch. 5 Treatment Principles pp. 96-124. Ch. 6. Assessment & treatment planning, 125-154.

Newman, M.G., and Stiles, W.B. (2006). Therapeutic Factors in Treating Anxiety Disorders. Journal of Clinical Psychology, 62, 6, 649-659.

Zimmerman, M. (1994) Interview Guide to the DSM IV, Mental Status Exam 120-124, and the anxiety disorders, 40-49, OCD, somatiform disorders 58-63.

Required Readings for Session 3:

Austrian, S. (2004). Mental disorders, medications and clinical social work. New York: Columbia University Press, Psychotropic Medication, 273-290 (read and reread as needed per various disorders.)

CME Resource. (2001). Caring for an Obsessive-compulsive disorder patient. Course 612, 1-30.

Elson, M. (1986). Transference and Countertransference, in Self Psychology and Clinical Social Work, NY: WW Norton: 67-76. (classic)

Gelso, C. and Carter, J. (1994). Components of the psychotherapy relationship: Their interaction and unfolding during treatment. Journal of Consulting and Clinical Psychology, 41,3, 296-306. (classic)

HMHL (2005). Meditation in psychotherapy. 21, 10, 1-4.

Greenberg, L. (1994). What is real in the relationship? Comments on Gelso and Carter, Journal of Consulting and Clinical Psychology, 41,3, 307-309. (classic)

Griffith & Griffith, Encountering the Sacred in Psychotherapy, 1-52.

Stanley, M. etal. (1996). Patterns of change during cognitive behavioral treatment for panic disorder. J. of Nervous & Mental Disease, 184, 9, 567-572.

Hill, N.R., and Beamish, P.M. (2007). Treatment Outcomes for Obsessive- Compulsive Disorder: a Critical Review. Journal of Counseling and Development, 85, 4, 504-510.

Further Readings (not required)

Badenoch (2008). The Three faces of mindfulness, 174-190.

West, M. et al. (1993). Anxious attachment as a determinant of adult psychopathology. Journal of Nervous and Mental Disease, 181, 7, 422 -427.

Zarate, R. & Agras, W. (1995). Psychosocial treatment of phobic & panic disorders. Psychiatry Interpersonal and Biological Processes, 57, 2, 133-141.

Session 4 & 5:

Traumatic Stress Disorders & Dissociative Disorders, Identity Disorder

A. Anxiety in relation to PTSD & dissociative disorders: the function of the defensive system, stress reactions vs. PTSD

B. Populations at risk: the sexually and physically abused, war survivors, rape survivors, holocaust survivors, cult survivors

C. Cultural, gender, and age variability in response to treatment: what we encounter in Southern California

D. Trauma and the brain, issues in practice: Working with traumatic attachment issues, neurobiological interventions, dyadic regulation of affect, self psychological techniques, expressive treatments, evidence-based treatments

E. Phasing in treatment: grounding, stabilization, reworking the trauma in the corrective emotional experience (connection, disruption & repair), CBT, supportive treatment, vs. flooding, suppression.

F. Effects on the worker, the continuum of care

Required Reading for Session 4:

Austrian, S. (2000). Mental disorders, medications and clinical social work. New York: Columbia University Press. Post Traumatic Stress Disorders & Ch 5, Dissociative Disorders, pp. 67-84.

Edmond, T., Sloan, L., and McCarty, D. (2004). Sexual abuse survivors’ perceptions of the effectiveness of EMDR and Eclectic therapy. Research on Social Work Practice, 14, 4, 159-272.

Fosha, D. (2002). Dyadic regulation and experiential work with emotion and relatedness in trauma and disorganized attachment. In Solomon, M. & Seigel, D. (2002). Healing Trauma. New York: Guilford.221-282. or:

Fosha, D. (2001) Dyadic Regulation of Affect. Journal of Clinical Psychology, 57, 2, 227-242.

HMHL (2005). Falling apart: Dissociation and its disorders. 1-4.

HMHL (1999). Neurobiological effects of early trauma, 4-6.

Mancini, C. (1994). Relationship of childhood sexual and physical abuse to anxiety disorders. Journal of Nervous and Mental Disease, 183, 5, 309-314.

Solomon, M. (2002). Connection, disruption and repair. In Solomon, M. & Seigel, D. Healing Trauma. New York: Guilford.pp. 322-346.

Glass, N., Perrin, N. et. al. (2007). The Protective Role of Tangible Support on Post-Traumatic Stress Disorder Symptoms in Urban Women Survivors of Violence. Research in Nursing and Health, 30, 5, 558-568.

Franco, M. (2007). Posttraumatic Stress Disorder and Older Women. Journal of Women and Aging, 19, 1/2, 103-117.

Required Readings for Session 5:

Badenoch. (2008). Ch. 5 Attaching: 52-75. Ch. 6: Picturing the inner community: 76-89. Ch. 16: the healing power of Sandplay. 220-243. (may read ch. 16 with personality disorders as well).

Goldstein, E. (2001). Ch 8, The middle phase, 186-215. Ch. 10 Treatment of clients with special problems, 241-267.

Homeyer, L. & Sweeney, D. (2005). Sandtray therapy. In C. Malchiodi (ed.). Expressive Therapies. New York, Guildford, 162-182.

Paivio, S. (1995). Resolving Unfinished business: Efficacy of experiential therapy using empty -chair dialogue. Journal of Consulting and Clinical Psychology, 63,3, 419-425. classic

Colson, B. (1995). Nightmare help of traumatic survivors with PTSD. Psychotherapy, 32, 3, 381-387. (classic)

Marmar, C.R., Foym D., Kagan, B., & Pynoos, R. (1999).An integrated approach for treating post traumatic stress. In Post-Traumatic Stress Disorder: A Clinical Review. Lutherville: The Sidran Press: p. 99-132.

Neborsky, R. (2002). A clinical model for the comprehensive treatment of trauma using an affect experiencing-attachment theory approach, In Solomon, M. & Seigel, D. (2002). Healing Trauma. New York: Guilford.282-321.

Rothbaum & Fog. Cognitive behavioral treatment for PTSD. In VanderKolk , B.A. & McFarlane, A.C. & Weisqeth, L. (eds). (1996). Traumatic Stress: The Effects of overwhelming experience of mind, body & society. New York: Guildford.491-509. classic

VanderKolk, B. in Solomon, M. & Seigel, D. (2002). Healing Trauma. New York: Guilford. EMDR and information processing in psychotherapy treatment. Pp. 168-195.

Trumbal, G. & McFarlane, A. Acute treatments in VandeKolk, B.A. (1996). A general approach to treatment of PTSD.

Turner, McFarlane & VanderKolk, (1996). Psychoanalytic psychotherapy or PTSD: the nature of the therapeutic relationship. In VanderKolk , B.A. & McFarlane, A.C. & Weisqeth, L. (eds). Traumatic Stress: The Effects of overwhelming experience of mind, body & society. New York: Guildford.537-558.

VanderKolk , B.A. & McFarlane, A.C. & Weisqeth, L. (eds). (1996). Traumatic Stress: The Effects of overwhelming experience of mind, body & society. New York: Guilford. See pages 417-440. 480-490, 491-509. 537-558 for interventions. classic

Zimmerman, M. (1994) DSM IV Interviewing Guide, 50-57.

Bisson, J.I., Ehlers, A., et. al. (2007). Psychological Treatments for Chronic Post-

Traumatic Stress Disorder. British Journal of Psychiatry, 190, 97-104.

Recommended

Holmquist, R.. & Bengt-Ake, A. (1996). Patients's contribution to the therapist's countertransference feelings. J. Of Nervous and Mental Disease, 184, 11, 660-666.

Meyer, W. (1993). In defense of long-term treatment: On the vanishing holding environment. Social Work, 38, 5, 571-578.

Session 6, 7 & 8: Working with Clients with Affective Disorders

A. Overview of Depressive disorders

B. Discerning the different and complex types of affective disorders: Clinical manifestations and diagnosis of unipolar and bipolar I & II disorder. Assessing dysthymic disorder, sub-clinical depressions, adjustment disorders, cyclothymic disorder, major depressive disorder, and depression within personality disorders and bereavement.

C. Bio-psycho-socio correlates, impact of the urban environment; cultural & gender diversity: the Los Angeles experience

D. Depression versus bereavement: Differing treatment strategies

E. Assessment for suicide

F. Treatment planning & differential intervention strategies: psychodynamic, interpersonal therapy (IPT) and cognitive models (CBT), bereavement therapy, crisis intervention, the use of medication-update, short-term vs. longer term treatment

F. Concomitant disorders & self medication: substance abuse, PTSD, personality disorders, eating disorders

G. Effects on the worker

Required Reading for Session 6:

Badenoch (2008). Ch. 7: The mutuality of the therapeutic relationship. 90-104.

Badenoch (2008). Ch. 9: Preliminary Thoughts:113-118.

Badenoch (2008). Ch. 10: Through the Lens of Diagnosis: Depression, Anxiety,

Dissociation & Addiciton: 119-152.

HMHL (2005) Dysthymia. February.

HMHL (2001). General Review - Bipolar Disorder- Part I & II. (17, 10&17, 11)

Zisook, S., and Kendler, K.S. (2007). Is Bereavement-Related Depression Different Than Non-Bereavement-Related Depression? Psychological Medicine, 37, 6, 779-794.

Required Readings for Session 7:

Austrian, S. (2000). Mental disorders, medications and clinical social work. New York: Columbia University Press. Ch.3, " Mood Disorders," 33-59 & Ch. 7, "Substance Related Disorders, 116-150.

Baker, F. (2001). Diagnosing depression in African Americans. Community Mental Health Journal, 37,1,31-38.

HMHL (1999). by Pauline Boss. Ambiguous Loss: Living with frozen grief, 16, 5

Palmer, C. (2001). African Americans, depression and suicide risk. J. of Black Psychology, 27, 1, 100-111.

Shear, K. et al. (2005). Treatment of complicated grief: A randomized controlled trial. J. Of the Am. Med. Assoc. 293, 21, 2601-08.

Zimmerman, M. (1994) DSM Interviewing Guide, 34-39

Lin, K.M., and Cheung, F. (1999) Mental Health Issues for Asian Americans. Psychiatric Services, 50, 6, 774-780.

Givens, J.L., Katz, I.R., et. al. (2007). Stigma and the Acceptability of Depression Treatments Among African Americans and Whites. Society of General Internal Medicine, 22, 9, 1292-1297.

Required Readings for Session 8:

Brisch, K. (2002). Treating attachment disorders from theory to therapy. New York: Guilford press. Depressive symptoms. pp. 208-213.

HMHL (2004). Interpersonal Psychotherapy, 21, 2, 1-3. August.

McBride, C. et al. (2006) Attachment as a moderator of treatment outcome in major depression: A randomized controlled trial of interpersonal psychotherapy vs. cognitive behavior therapy. J. of Consult. & Clin. Psychol. 74, 6, 1041-54.

Markowitz, J.C., Skodol, A.E., et. al. (2006). Interpersonal Psychotherapy for Borderline Personality Disorder: Possible Mechanisms of Change. Journal of Clinical Psychology, 62, 4, 431-444.

Clarkin, J.F., Levy, K.N., et. al. (2007). Evaluating Three Treatments for Borderline Personality Disorder: a Multiwave Study. American Journal of Psychiatry, 164, 6, 922-928.

Karasz, A., and Watkins, L. (2006). Conceptual Models of Treatment in Depressed Hispanic Patients. Annals of Family Medicine, 4, 6, 527-533.

De Mello, M.F., de Jesus Mari, J., et. al. (2005). A Systematic Review of Research Findings on the Efficacy of Interpersonal Therapy for Depressive Disorders. European Archives of Psychiatry and Clinical Neuroscience, 255, 2, 75-82.

Beevers, C.G., Wells, T.T., et. al. (2007). Predicting Response to Depression Treatment: The Role of Negative Cognition. Journal of Consulting and Clinical Psychology, 75, 3, 422-431.

Further Reading

Palombo, J.(1985). Depletion states and self object disorders. Clinical Social Work Journal, 13,1, 32-49 (classic).

Catalano, G. (2005). Bereavement, Depression, and Our Growing Geriatric Population. Southern Medical Journal, 98, 1, 3-4.

Session 9: Eating Disorders

A. Completing a thorough diagnosis of eating disorders

B. Examining the impact of our own cultural ideals and acculturation issues

C. Treatment regimens

D. The containment of anxiety and depression; coexisting conditions: personality disorders; sexual abuse and PTSD

E. Phasing in treatment with varying strategies, knowing the treatment protocol: stabilization and hospitalization, adjunctive treatments (family therapy, group treatment, and nutritional counseling)

Required Readings

Austrian, S. (2000). Mental Disorders, Medications and Clinical Social Work. New York: Columbia University Press. Ch. Eating Disorders, 151-174.

Badenoch (2008). Ch. 11. Grounding therapy in the right brain. 153-162.

Goldstein (2001). Ch. 7, The beginning phase, pp. 155-185.

McIntosh, VVW, et al. (2005). Three psychotherapies for anorexia nervosa: A randomized controlled trial. Amer. J. of Psychiat. 162, 4, 741-47.

Waller, G. (1994). Borderline personality disorder and perceived family dysfunction in the eating disorders. Journal of Nervous and Mental Disease, 182,10, 541-546.

Bein, A. (2000). Service delivery issues in early termination of Latino clients. Journal of Human Behavior in the Social Environment, 3, 2, 43-59.

Zimmerman, M. (1994) DSM Interviewing Guide, 8-11, 66 & 67.

Bennett, S., and Dodge, T. (2007). Ethnic-Racial Differences in Feelings of Embarassment Associated with Binge Eating and Fear of Losing Control. International Journal of Eating Disorders, 40, 5, 454-459.

Hepworth, N., and Paxton, S.J. (2007). Pathways to Help-Seeking in Bulimia Nervosa and Binge Eating Problems: a Concept Mapping Approach. International Journall of Eating Disorders, 40, 6, 493-504.

Hay, P.J. (2007). Understanding Bulimia. Australian Family Physician, 36, 9, 708-713.

Recommended

Cummins, L.H., Simmons, A.M., et al. (2005). Eating Disorders in Asian Populations: a Critique of Current Approaches to the Study of Culture, Ethnicity, and Eating Disorders. American Journal of Orthopsychiatry, 75, 4, 553-574.

Session 10, 11, 12: Personality Disorders

A. Personality disorders: Variability in gender and culture: what we see in Los Angeles

B. Complex & co-occurring disorders, personality disorders in relation to trauma, anxiety, unipolar & bi-polar depression

C. Diagnosis, treatment planning & intervention; synthesizing treatment modalities such as Dialetical Behavioral Therapy, Object Relations treatment, CBT, Self Psychology, and supportive therapy

D. Effects on the worker, values, on labeling of clients

E. Continuum of Care

Required Reading for Session 10:

Austrian, S. (2000). Mental disorders, medications and clinical social work. New York: Columbia University Press. Ch.9, Personality Disorders, 175-213

Cushman, P. (1990). Why the self is empty. American Psychologist, 45, 5, 599-611. (classic).

HMHL (2000). Personality Disorders (Part 2), 16, 10;

Valliant, G. (1994). Ego mechanisms of defense and personality psychopathology. Journal of Abnormal Psychology, 103,1, 44-50. classic

HMHL (2000) Expressed emotion & Borderline Personality, 16, 10, 1-7.

HMHL (2000). Anitsocial Personality – Part I and (Part 2). 17, 6&17, 7, 1.

HMHL (2004). Narcissism and Self Esteem, 20, 8, 1-4.

Required Reading for Session 11:

Badenoch (2008). Ch. 12: Listening to family histories. 163-173.

Badenoch (2008). Ch. 15: Patterning the internal work.205-219.

HMHL (2000). Widiger, T. Gender Bias in the Diagnosis of Personality Disorders, 16, 10

Glickauf-Hughes, C. (1995). Narcissistic issues in therapists: Diagnostic and treatment considerations. Psychotherapy, 32, 2, 213-221. classic

Brisch, K.(2002). Treating attachment disorders from theory to therapy. New York: Guilford press. Borderline symptoms, 200-225.

Goldstein, E. (2001). Ch. 9, Treatment of clients undergoing stressful life events. 216-240.

Required Readings for Session 12:

Kraus, G. & Reynolds, D. (2001). The abc’s of cluster b’s: Identifying, understanding & treating cluster b personality disorders. Clinical Psychological Review, 21,3, 345-373.

Zimmerman, M. (1994). DSM Interviewing Guide, 87-119.

Kernberg, O.F. (2007). The Almost Untreatable Narcissistic Patient. Journal of the American Psychoanalytic Association, 55, 2, 503-539.

Gunzburg, M. (1995). The use of combined individual, group, and marital therapy to resolve the narcissistic transference. International Journal of Group Psychotherapy, 45, 2, 251-258. classic

Kellogg, S.H., and Young, J.E. (2006). Schema Therapy for Borderline Personality Disorder. Journal of Clinical Psychology, 62, 4, 445-458.

Gunderson, J.G., Bateman, A., et. al. (2007). Alternative Perspectives on Psychodynamic Psychotherapy of Borderline Personality Disorder: The Case of “Ellen”. American Journal of Psychiatry, 164, 9, 1333-1339.

Further Reading

Hamilton. N. (1990). Self and Others: Object Relations Theory in Practice. Northvale, NJ: Jason Aronson, Chs. 14, 15, 205 -250.

Edman. J. (1999). Filipino American beliefs about the causes and treatment of mental Problems. Cultural diversity and ethnic minority psychology, 5,4, 380-386.

Goldstein, E. (2005). Borderline Disorders. New York: Guilford.

Grilo, C.M., Becker, D.F., et al. (2004). Diagnostic Efficiency of DSM-IV Criteria

For Borderline Personality Disorder: an Evaluation in Hispanic Men and

Women With Substance Use Disorders. Journal of Consulting and Clinical

Psychology, 72(1), 126-131.

Session 13: Practice with the Severely Mentally Ill.

A. The impact of the system on client: issues of social justice

B. Issues in client diversity: class, race, gender, ethnicity, and religion

C. Assessment & treatment of the psychoses: schizophrenia, schizoaffective

disorder, and psychotic depression, rehabilitation therapeutic case

management, Assertive Community Treatment

D. Complex & multiple diagnoses: dual diagnosis (substance abuse), PTSD

E. Working with clients from diverse backgrounds in the urban environment

F. The continuum of care, inpatient and day treatment services, case

management issues

G. The new medications

H. Effects of the worker

Required Reading

Austrian, S. (2000). Mental disorders, medications and clinical social work. New York: Columbia University Press. Ch 6, "Schizophrenia," 85-104; Ch. 12, "Psychotropic Medications," 93-115.\

Guarnaccia, P. et.al. (1992). Si Dios Quiere: Hispanic families' experiences of caring for a seriously ill family member. Culture, Medicine & Psychiatry, 16, 2, 187-215. classic

HMHL (2001). How schizophrenia develops: New Evidence and new ideas. 17,8, 1-4.

HMHL (2000). Hoagarty, G. Cognitive rehabilitation of schizophrenia, 17, 2, 4-6.

King, S. & Dixon, M. (1996). The influence of expressed emotion, family dynamics, and symptoms type on the social adjustment of schizophrenic young adults. Archives of General Psychiatry, 53, 1098-1104.

Newhill, C. (1990). The role of culture in the development of paranoid symptomatology. American Journal of Orthopsychiatry, 60,2, 176-185.(classic)

Zimmerman, M. (1994).Interview Guide for Evaluating DSM –IV Psychiatric Disorders. 22-25.

Kilbourne, A.M., Bauer, M.S., et. al. (2005). Clinical, Psychosocial, and Treatment Differences in Minority Patients with Bipolar Disorder. Bipolar Disorders, 2005, 7, 1, 89-97.

Leahy, R. (2007). Bipolar Disorder: Causes, Contexts, and Treatments. Journal of Clinicla Psychology: In Session, 63, 5, 417-424.

Mansell, W. (2007). An Integrative Formulation-Based Cognitive Treatment of Bipolar Disorders: Application and Illustration. Journal of Clinical Psychology: In Session, 63, 5, 447-461.

Recommended

Morris, C., Miklowitz, D., et. al. Family-Focused Treatment for Bipolar Disorder in Adults and Youth. Journal of Clinical Psychology: In Session, 63, 5, 433-445.

Goldberg, J. (2007). What Psychoherapists Should Know About Pharmacotherapies for Bipolar Disorder. Journal of Clinical Psychology: In Session, 63, 5, 475-490.

Session 14: Gender-Sensitive Social Work Practice in Mental Health

(topics to be determined by class and professor)

A. Impact of historical theory on current scene

B. Differential diagnosis (who receives what type of diagnosis, why and by

whom)

C. Gender issues in the therapeutic relationship

D. Developmental issues (life-cycle) and treatment of women, men, lesbians and gay men

E. What we see in Southern California and in the military community: Cultural

and gender diversity, treatment implications

Required Reading

Badenoch (2008). Ch. 17 Doing Art. 244-265.

Land, H. (1995). Clinical social work. In Nan Van Den Berg (Ed). Feminist practice in the twenty-first century. Washington, D.C.: NASW Press. classic

Low, G. (2000). Latinas and sexual assault: Towards culturally sensitive assessment and intervention. Journal of Multicultural Social Work. 8, 1/2, 131-157.

Lukes, C. and Land, H. (1990). Biculturality and homosexuality. Social Work, 35, 2: 155-162.(classic)

Kessler, L., and Waehler, C. (2005). Addressing Multiple Relationships Between Clients and Therapists in Lesbian, Gay, Bisexual, and Transgender Communities. Professional Psychology: Research and Practice, 36, 1, 66-72.

Ruiz, P., Lile, B., et. al. (2002). Treatment of a Dually Diagnosed Gay Male Patient: A Psychotherapy Perspective. American Journal of Psychiatry, 159, 2, 209-215.

Recommended

Robins, J. (1983). Complex Triangles: Uncovering Sexist Bias in Relationship Counseling, in Robins, J. (Ed.) Women Changing Therapy. New York: Haworth Press, pp. 159-169. (classic)

Session 15: Issues for Social Work Practitioners: Integration and Synthesis (Obj. 6 & 7). (Selection among the following topics to be determined by instructor and class.)

A. Functioning in a multi-disciplinary mental health team: leadership issues

B. Identity of the social worker, developing a unifying philosophy for mental health

C. Court appearances and testifying as expert witnesses; values and ethics

D. Informed consent and issues of confidentiality

E. The sexual dimension in treatment

F. Monitoring practice

G. HBSE, policy, & research courses in the mental health concentration

D. Influence of mental health service delivery system on clients

E. Understanding advocacy issues in mental health, client rights.

F. Course evaluation

Required Reading

NASW, Code of Ethics in Encyclopedia of Social Work

SW 645: Literature Book List for Reflective Journal

The following list represents topics we have covered in class. Select one book from the literature list and comment on the piece as a clinical social work student in the field of mental health. You may comment throughout the course but you must draw the piece together into a cohesive whole at the end. Discuss your impressions of the piece holistically, mental health issues that come up in the book, your assessment of the issues, how you might address these issues as a mental health social work practitioner, issues of countertransference for you, while applying material we have covered in class. In addition, please comment on thoughts and feelings you have throughout the course on cases held in the field, and news-worthy events as they relate to your readings and the book you select from the literature list. HOW DOES THE WORK AFFECT YOU AS A CLINICIAN and AS A HUMAN BEING? This is an integrative assignment (8-10 pages).

Covers objectives 1, 3, 4, 6a

Book List:

Kingsolver, B. The Poisonwood Bible

Sue Monk Kidd, The Secret Life of Bees

Sue Monk Kidd, The Mermaid Chair

Tim O’Brien, The Things They Carried

Gordon, M. The Other Side; Final Payments; In the Company of Women; Pearl

Irving, J. A Prayer for Owen Meany

Keysen, S., Girl Interrupted

Gail Parent, Sheila Levine Is Dead and Living in New York

John Steinbeck, East of Eden

John Steinbeck, Cannery Row

Styron, Darkness Visible

Waugh, E. Brideshead Revisisted.

Cather, W. Paul's Case.

Kennedy, W. Ironweed.

Chase, T. When Rabbit Howls.

Mason, B. In Country.

Otto, W. How to Make an American Quilt.

Carson McCullers, The Heart is a Lonely Hunter

Carson McCullers, Reflections in a Golden Eye

Carson McCullers, Member of the Wedding

Nora Zeale Hurston, Their Eyes Were Watching God

Alice Walker, The Color Purple

Toni Morrison, The Bluest Eye

Carol O’Connell, Mallory’s Oracle

Amy Tan, The Joy Luck Club.

Chaim Potok, My Name is Asher Lev.

Chaim Potok, I Am the Clay

Russo, R. Empire Falls;

Russo, R., Bridge of Sighs

McCort, F. Angela's Ashes.

Weisel, E. Night.

Camus, A. The Stranger

Tennessee Williams, The Glass Menagerie

Moody, The Coming of Age in Mississippi

Sandra Cisneros, The House on Mango Street

Julia Alvarez, How the Garcia Sisters Lost their Accent

Tobar, H. The Tattooed Soldier

Benjamin Saenz, Sammy and Juliana in Hollywood

Benjamin Saenz, Carry Me Like Water

Denise Chavez, Loving Pedro Enfante

William Faulkner, As I Lay Dying

Ondaatje, The English Patient

McEwan, I. , Atonement;

McEwan, I., On Chesil Beach

Oscar Wilde The Picture of Dorian Grey

Saphire, Push

Ablom, M., Tuesdays with Morrie

Applegate, D., The Most Famous Man in America

John Kennedy Toole, The Confederacy of Dunces

Schlink, B., The Reader

Jane Smiley 1000 Acres

Rebecca Wells, Divine Secrets of the Ya Ya Sisterhood

Jeffrey Eugenies, Middlesex

Toiban, C., Brooklyn

Myla Goldberg, Bee Season

Julia Glass, Three Junes

Arthur Phillips, Prague

Johnathan Franzen, Freedom

University of Southern California SW 645

School of Social Work Sharon Wheeler

GUIDELINES FOR THE RESEARCH PAPER

Students: I advise that you use this sheet as a check list before you turn in your paper. Covers all objectives (1, 2, 3, 4, 5, 6, 7). Begin this assignment at least 3 weeks before it is due.

1. Select a disorder or special population, preferably one that relates to a case you are holding, changing data/names explicitly to ensure confidentiality.

2. Select an intervention strategy for the disorder/population. Examine intervention strategies from referral & engagement to follow-up [a] referral and engagement [b], assessment framework from practice model chosen and DSM diagnosis [ c ], treatment planning [d] practice/treatment model [e] evaluation, [f] follow-up. You may use one or more than one practice model but you must explain your rationale for doing so. (obj. 2, 4)

3. Use an approach and practice model suitable for work with individuals and their support systems.

4. Remember that your assessment should be based on the practice intervention selected, not just DSM diagnosis. Your intervention should derive from your assessment. The core phase should be in line with the assessment issues. Evaluation should follow the same practice intervention as in the assessment. Explain why you are doing what you are doing. The core phase should represent the bulk of your paper and be detailed. Case material is integrated throughout.

5. This assignment is not a case study. Present case material to illustrate or provide confidential examples for your practice model assessment or theoretically-based intervention strategies. Your case material should be used only as illustration.

6. Identify the segment (s) of the continuum of care where are you most likely to be working and explain why this is so. Identify and explain factors that might influence client use of mental health care. (obj. 5)

7. Important: Discuss issues that can affect the worker client relationship, such as your own feelings, transference and countertransference, values and experiences that may affect motivation or resistance in you and/or the client system in treatment. (obj. 3)

8. Remember to include content on providing treatment to diverse client groups living in complex, urban environments throughout your paper. How is work in San Diego different from other Southern California communities? Comment on social justice issues as they impact problem presentation and treatment (obj. 1)

9. Discuss your role and identity as a clinical social worker; what makes your domain different from other professionals in working with this issue? What leadership responsibilities do you have in team activities? (obj. 6)

10. What ethical issues are involved in working with this group? What social work values intersect with these ethical issues? (obj. 7)

11. Use APA style. APA style includes the use of headings and subheadings. Start with an introduction and end with a conclusion. Do not use lengthy citations. Paraphrase material to make your point. When you quote directly, you must include pagination and attribution. If you are unclear about APA style, consult the manual.

12. Do a literature search and use a variety of sources to inform your work. I expect a minimum of 8-9 references in an assignment of this nature. Do not rely heavily on one or two texts. Do not use introductory texts from your Foundation year practice courses, such as Hepworth & Larsen or Shulman.

13. A good idea is to select the same disorder or special population for your practice course as for your HBSE course, and even your research course. This choice will provide you with integration of content and a greater depth of knowledge (obj. 1)

14. The paper should be 15 to 20 double spaced pages using Times Roman 12 point font.

l5. Please email or see me if you have any questions. I am happy to meet with you to go over problem areas and answer questions, and I respond promptly and in detail to emails.

16. If for some reason, you are unable to turn in your paper on time, please contact me. Do not turn in your paper late without contacting me; otherwise, your grade will drop. Together, we will negotiate a solution to the problem. If an extension is given and the paper is not submitted by the date of the extension, points will be deducted and your grade will drop.

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