Behavioral Methods in Social Welfare

Steven Paul Schinke, James. K Whittaker, Scott Briar

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781351327343
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

"Behavioral Methods in Social Welfare" offers positive proof that behaviorism has come of age in social work. Steven Paul Schinke and the contributors to this volume are social work practitioners who document their attempts to extend the basic tenets of behavioral psychology from the laboratory, clinic, and classroom to the full range of client groups and social problems that make up the practice of social work. In social work education, traditionally to the extent it appeared in the curriculum at all, behavioral content appeared in electives or in courses not focused on practice. It is a true measure of progress that behavioral methods are now visible, integral component of social work education and practice.The authors of each piece in this collection indicate progress in developing an empirically based approach to social work practice. Despite the impressive documentation contained in the present volume, no conclusive evidence as to the effectiveness of behavioral methods exists. What behavioral methods do offer, however, is a systematic format for both problem intervention and evaluation that, over time, should produce a more empirically based practice. A promising sign, well documented in the present effort, is the facility with which this book has subjected practice procedures to the rigor of research and evaluation.This blending of clinical practice and research develops the sense of competence that student-practitioners acquire in understanding and controlling both the art and science of their clinical practice. Steven Schinke and his colleagues offer a series of "snapshots" of important work in process. Their collective portrait provides a fresh perspective and new stimulus for all social work practice, as well as an affirmation that disciplined, responsive, and sensitive social work intervention can make a difference in the lives of people.

II

Behavioral Methods With Adults

BEHAVIORAL METHODS WITH ADULTS

Certainly, all behavioral procedures noted in the foregoing section are applicable to social work with adults. Tangible and social reinforcement, observable outcome goals, and contingency contracts are germane for any client group and presenting problem. Nonetheless, the attributes and struggles of adulthood demand special consideration. Their developed cognitive ability lets adults assume major responsibility for their own treatment. Likewise, this ability limits intervention. Adults can easily not comply with the behavioral regimen, elect to drop out of treatment, or intentionally or inadvertently undercut efforts intended for their own betterment. Adults significantly influence their personal environments and so can uniquely tailor intervention. Just as readily, however, they can perpetuate and maintain damaging patterns and lifestyles. An asset in all behavioral work with adults is that their years give them skills to cope with surviving childhood handicaps or maladjustments, howsoever these may unduly restrict them. Regardless of intellectual and physical wherewithal, adults shoulder the burden for their economic security.

The six chapters comprising this section take up such issues in the orchestration of behavioral social work for adults. The sophisticated potential and the accompanying problems of thought processes in adulthood are highlighted in the treatment of excessive self-criticism. Cognitions and behavior are associated with assertiveness and with heterosexual functioning. Adult problems that surround substance addiction raise the challenge of social work with clients who derive powerful rewards from bad habits. Habilitation with mentally handicapped persons exhibits the economic payoffs of behavioral training for those excluded from competitive employment. Redressing the inequities that fall to older persons in institutional care manifests how social workers can improve the lot of a growing, disenfranchised minority.

Across these clients and troubles are commonalities that gird behavioral social work with adults. For example, each chapter emphasizes rehearsal of new behavior. Sharon Berlin uses rehearsal to help woman learn to be less self-deprecatory. In small groups, clients imagine problem situations and come up with statements to combat negative thoughts. After voicing self-statements, clients silently think to themselves of new adaptive response. Women in Cheryl Richey’s assertiveness groups gain desired skills through rehearsal while other clients act as coaches and antagonists. Wayne Duehn and Nazneen Mayadas preface rehearsal sessions by showing women and men ways to relieve sexual dysfunctioning by talking to themselves, visualizing sexual activities, saying positive thoughts aloud or in whispers, and covertly rehearsing self-statements.

Betty Blythe pits rehearsal against ingrained cigarette smoking. She further relates the technique to social work intervention responsive to alcohol abuse and to overeating. Developmentally disabled clients prospered when Rick Grinnell and Alice Lieberman facilitated their rehearsal of nonverbal and verbal behavior. Later, clients are able to employ these responses during interactions with job interviewers. Ray Berger outlines a stepwise approach to give nursing home residents greater control of a regimented environment. Admirable in Berger’s program is the preassessment of clients’ social competence. Together these six chapters portray a remarkable concinnity of social-learning methods. The authors and their data paint an exciting future for behavioral social work with adults.

8

Women and Self-Criticism

Sharon B. Berlin

Self-criticism is the process of negatively evaluating ones’ attributes, motives, and actions. Psychological constructs of self-criticism and low self-esteem refer to similar phenomena: self-criticism is a discrete act of negative self-evaluation; low self-esteem describes a global, pervasive sense of worthlessness. Habitually evaluating self-performance as inadequate and negatively appraising personal and physical characteristics lowers overall self-opinion, ultimately resulting in low self-esteem. Determining whether chronic self-criticism leads to low self-esteem, or whether the pervasive sense of worthlessness is impetus for self-criticism is academic; of more clinical relevance is recognizing that these phenomena occur concomitantly, each influencing the other.

Depression refers to episodic low-mood experiences, a syndrome or cluster of symptoms, or to a disease entity with specificable cause, course of illness, prognosis, and treatment (Becker, 1977; Weissman & Paykel, 1974; Mendels, 1970). Depression as low-mood or more serious affective disorder involving several symptoms may be implicated in the self-criticism, low self-esteem cycle. Certainly, people can talk or think themselves into gloomy low moods or into states of anxious arousal (Beck, 1976). Negative self-attribution also appeares to be a major component—if not a precipitating condition—of the depression syndrome (Beck, 1974; Lewinsohn, 1975; Seligman, 1975). Transiently common to most people and sometimes helpful, self-criticism warrants clinical attention when it usurps the ability to feel adequate, experience pleasure, and take corrective action.

Self-criticism is particularly prevalent among women. Data from state and county mental hospitals, community mental health centers, and needs assessment surveys show rates of treated and untreated depression disproportionately higher among women than men across all age groups (Goldman & Ravid, in press). Epidemiological studies from the United States, England, and Scandinavia show more women than men reporting symptoms related to depression. Estimates are that twenty to thirty percent of all females experience moderately severe depression episodes at some point in adulthood (Goldman & Ravid, in press).

Explanations offered to account for sex differences in rates of depression include hormonal imbalance, genetic predisposition, women’s greater readiness to acknowledge subjective distress, and the powerless-ness of traditional female roles (Klerman & Weissman, in press; Spitzform, 1978). Assimilation of social attitudes has also been widely implicated: compared to men, women learn to expect less success, express less confidence in their abilities, and take more personal responsibility for frustration and failure (Maccoby & Jacklin, 1974; Bogo, Winget, & Gleser, 1970; Jacklin & Mischel, 1973). Although knowledge of the etiology remains tentative, most agree that the causes of depression are complex and heterogenous (Akiskal & McKinney, 1973; Becker, 1977).

Because depression is a serious and growing mental health problem, the last decade has witnessed increased efforts to develop appropriate intervention strategies. In addition to pharmacological approaches (Bielski & Friedel, 1976), relatively new psychological strategies based primarily on behavioral and cognitive-behavioral conceptualizations show promise in remediating depression symptoms (Fuchs & Rehm 1977; Rush, Beck, Kovacs, & Hollon, 1977; Shaw, 1977). Little attention, however, has been given to developing and empirically testing intervention methods for related and equally insidious problems of chronic self-criticism.

Describing one approach to this problem, the present chapter outlines the development and evaluation of a cognitive-behavioral intervention package for women who self-criticize excessively. Intervention focused on helping female clients learn to be more aware of self-criticism, to evaluate its validity, to modify inappropriate self-criticism, and to achieve individual performance goals. Behavioral techniques allow clients to modify unrealistic performance standards, inaccurate interpretations of events, and selective attention to negative outcomes. Also included in this chapter is a discussion of the theoretical and empirical literature forming intervention rationale, a description of study process and findings, and implications for practice.

Supporting Literature

Intervention was based on a cognitive-behavioral perspective, viewing emotional experiences and overt action shaped by personal and environmental events. Contrasted with traditional learning-theory precepts that behavior is controlled solely by environmental consequences, cognitive-behavioral theorists suggest environmental occurrences are simply information sources, differentially attended to, interpreted, evaluated, retained in memory, and used to guide behavior. Environmental events are mediated by cognitive processes (Bandura, 1977a; Mahoney, 1974; Meichenbaum, 1977). Because such processes are learned, they are modifiable through behavioral procedures of modeling, rehearsal, reinforcement, and environmental practice (Goldfried & Davison, 1976; Kazdin, 1974a, 1974b).

Conceptualizing human functioning in terms of cognitive processes has stimulated the development of many new intervention strategies. Data supporting cognitive-behavioral theory has been primarily derived from clinical and analogue trials. Albert Ellis (1962), among the first to devise clinical procedures to modify cognitions, focused on “irrational ideas.” Ellis’s emphasis on the irrationality of subjective distress and unconditional self-acceptance has been faulted by some (Bandura, Adams, & Beyer, 1977; Mahoney, 1974) and outcome studies of his Rational Emotive Therapy (RET) have produced unclear results (Mahoney, 1977). Nonetheless, many RET components have been profitably incorporated into more recent and effective approaches (e.g., Beck, 1976; Meichenbaum, 1977).

Contributing substantially to cognitive-behavioral intervention procedures, Meichenbaum (1977) has trained clients to “talk to themselves” in a self-guiding fashion. Meichenbaum’s self-instructional approach is based largely on research (Klein, 1963; Mischel, 1975; Patterson & Mischel, 1976) investigating children’s self-verbalization as facilitating task mastery. Reasoning that overt and covert self-speech helps people learn new tasks and cope with difficult problems, Meichenbaum’s clinical paradigm includes three steps: 1) problems are defined to make them amenable to intervention and to increase client sense of control and expectations for positive results; 2) clients observe their own maladaptive thoughts and behaviors to increase occurrence sensitivity; 3) new awareness of self-criticism becomes the cue for incompatible thoughts and adaptive behavior.

Concerned with anxiety reduction, research by Goldfried and associates (Kanter & Goldfried, 1976, Goldfried, Linehan, & Smith, 1976) has yielded support for cognitive-behavioral intervention. Goldfried explains anxiety as a function of thoughts and self-appraisals made prior to and during anxiety eliciting situations. Evidence shows beliefs about negative behavioral consequences—especially others’ negative reactions—correlate highly with social anxiety (Goldfried & Sobocinski, 1975). Rational restructuring interferes with such maladaptive beliefs by: 1) presenting the rationale that feelings are affected by how people appraise situations and by their coping abilities; 2) assessing client assumptions and self-statements about anxiety arousing situations; 3) analyzing self-statements to decide if they are realistic projections of probably outcome; 4) teaching clients to modify irrational statements using anxiety reactions as cues for the more accurate assessment of situations and coping skills; and 5) helping clients practice this sequence through imaginal rehearsal.

This intervention paradigm has been found effective in reducing interpersonal anxiety (Kanter & Goldfried, 1976) and test anxiety (Goldfried, Linehan, & Smith, 1976). Also applying the model to assertiveness training, Goldfried (1976) suggested unassertive behavior is often maintained by concern with reactions of others, rather than by skill deficits. Supporting this analysis, Schwartz and Gottman (1974) showed cognitive restructuring superior to behavioral rehearsal in increasing assertiveness. Similarly, Glass and his associates report rational self-statements effective in improving heterosexual interactions among college students (Glass, Gottman, & Shmurak, 1976).

The efficacy of cognitive-behavioral techniques has also been established in the treatment of depression. Rush, Beck, Kovacs, and Hollon (1977) report that clinically depressed clients receiving cognitive-behavioral intervention showed greater improvement than did clients receiving tricyclic pharmacotherapy. Based on Beck’s concept of depression as resulting from negative cognitions (1974), intervention consisted of teaching clients to recognize connections among cognition, affect, and behavior; monitor negative thoughts; examine evidence for and against distorted cognitions; and substitute reality-based interpretations for distorted negative cognitions. Since most previous comparative studies found pharmacotherapy more effective in reducing depression symptoms (e.g. Covi, Lipman, Derogatis, Smith, & Pattison, 1974; Friedman, 1975; Klerman, DiMascio, Weissman, Prusoff, & Paykel, 1974), the Rush, Beck, Kovacs, and Hollon (1977) effort represents a landmark study.

Comparing Beck’s cognitive app...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgments
• Authors
• Foreword
• Introduction
• I. METHODS FOR CHILDREN AND FAMILIES
• II. BEHAVIORAL METHODS WITH ADULTS
• III. PROFESSIONAL COMPETENCE AND ACCOUNTABILITY
• References
• Author Index
• Subject Index