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Course presentation including my personal group leadership style as well as a discussion of Third Wave therapy
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© D
avid W. B
utler 2009©
Da
vid W
. Bu
tler 2
00
9
David Butler
Social Work Group Leadership Style and Integrative
Theoretical Perspective
© D
avid W. B
utler 2009
The following presentation is an extension of my personal philosophy of practice to the practice of group psychotherapy. This is, of course, a work in progress and will be modified by my continued learning.
I will focus on two primary themes. The first, and possibly most pragmatic, is a synthesis of some of the more traditional approaches, with a particular emphasis on humanistic theories. The second theme is more of an ideal based on the relatively new, yet evidence-based practice of mindfulness which provides the significant advantage of including compassion and acceptance as core components.
Introduction
© D
avid W. B
utler 2009
Core beliefsPeople desire happinessPeople have the potential
forSelf-awarenessSelf-determinationSelf-actualizationCompassion for self and
othersPrimacy of the therapeutic
relationshipPeople as human beings as
opposed to human doingsPersonal responsibility
Therapy is most effective when:ExperientialCollaborativePhenomenologicalHolistic
MindBodySpiritEnvironment
EgalitarianShared journey
“As human beings we all want to be happy and free from misery” His Holiness the Dalai Lama
© D
avid W. B
utler 2009
ExistentialSelf-determinationPersonal
responsibilityExistential anxiety
The “hole in the soul”
Authenticity
Therapeutic relationshipNecessary and
(maybe) sufficientGenuinenessUnconditional
positive regardAcceptanceEmpathy
Traditional theoretical foundations
Person-centered
“man is, before all else, something which propels itself towards a future and is aware that it is doing so”. Sartre
© D
avid W. B
utler 2009
GestaltHolismExperientialIntegrating
polaritiesInterpersonal
conflictUnfinished business
GamesLife scriptsEgo statesStrokesInjunctions
Traditional theoretical foundationsTransactional analysis
“Remember, be here now.” Ram Dass
© D
avid W. B
utler 2009
AdlerianHolismSelf-determinationPersonal
responsibilityCollaborative
partnership
PsychoanalysisTransferenceDevelopmental
stagesSolution-focused
brief therapyclient-centeredcounselor-as-
consultant
Traditional theoretical foundations
Other
© D
avid W. B
utler 2009
AdvantagesEmpirical data
Designed to be scientifically evaluated
FundingSupported by third
party payers and, consequently, many agencies
Brief
ImpersonalEmphasis on
thoughts and behaviors, not feelings or experiences
Cognitive Behavioral Therapy
Disadvantages
© D
avid W. B
utler 2009
Preferred
Existential therapyPerson-centeredGestaltAdlerianTransactional
analysis
Cognitive behavioralCBTCognitive
restructuringDBT
Theoretical foundations
Pragmatic
There appears to be a clear disconnect between my preferred orientation toward the humanistic approaches and the current emphasis on cognitive behavioral therapies. However, there is hope for reconciliation, thanks to…
© D
avid W. B
utler 2009
While my heart is with the humanistic approaches, especially person-centered and existential, the current emphasis on CBT cannot be ignored.
Synthesis
© D
avid W. B
utler 2009
The Third WaveMore person centeredAcknowledges humanistic
conceptsLess ‘clinical’Mindfulness-based Stress
Reduction (MBST)Mindfulness-based cognitive
therapy (MBCT; Segal, Williams, & Teasdale, 2002)
Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999)
DBT
© D
avid W. B
utler 2009
MindfulnessAdds experiential
component to CBTAlso known as
Presence-centered psychotherapy
Contemplative psychology
“technology of the mind”
Mindfulness-based Stress Reduction (MBST)
Mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2002)
Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999)
DBT
© D
avid W. B
utler 2009
Evidence of effectiveness in treatingStress disorders (Weinstein, et a., 2009)Depression
Including reduction in relapse rates (Attentional problemsPain managementMedical management (diabetes)Potential (tentative results)
Substance abuseGeneralized Anxiety Disorder
Mindfulness
© D
avid W. B
utler 2009
Self-compassionSelf-kindness versus self-judgmentCommon humanity versus isolationMindfulness versus over-identificationDeactivates threat system and activates self-soothing
systemResearch indicates improvement in depression, anxiety,
rumination, thought suppression, social connectedness and emotional intelligence (Neff, 2003)
“Self-compassion involves having the right amount of distance from one’s emotions so that they are fully experienced while being approached with mindful objectivity” (140)(Neff et al., 2007)
Mindfulness concepts
© D
avid W. B
utler 2009
Advantagespeer support and motivationShared insightReduced isolation
DisadvantagesRequires therapist training in both group work
skills and mindfulness therapyMay require unlearning of incompatible skills
Mindfulness in group setting
Melbourne Academic Mindfulness Group, 2006
© D
avid W. B
utler 2009
Limited long-term follow-up data(Mis)perception of mindfulness as a spiritual
practiceSubstantial client commitment
45 minutes of daily practice typically recommendedPossibility of exacerbation of psychiatric symptoms,
especially with long-term (e.g. 10 day) retreats (Melbourne Academic Mindfulness Group, 2006) Altered reality testing (with transcendental, as
opposed to mindfulness, meditation)May be contraindicated for current or past psychosis
Mindfulness limitations
© D
avid W. B
utler 2009
Leader as guideShared journey of discoveryTechnical expert but not expert in the lives of
the membersLeast directive, least structured
Assumes the development of a safe environment
Whenever possible, the group should determine its own direction and structure
More structure often required in the early and late stages of the group
Leadership Style
© D
avid W. B
utler 2009
One size does not fit all Beginnings
Structure and safety Optimism for change within group Teach essential concepts of cognitive therapy
Automatic negative thoughts Relationship between cognition and emotion
Basic mindfulness training Relaxation Mindful meditation Attachment/acceptance
Working Egalitarian Equal partners Person-centered, Adlerian, Existential
Endings Switch to more cognitive behavioral approach Skills training
Ideal model
© D
avid W. B
utler 2009
StyleNon-directiveEgalitarian
Equal partners on a journey
Each with unique strengths and contributions
Genuine (Rogers)Least directive
Actual amount of direction dependent on needs and abilities of members
GuideTeacher
Mindfulness concepts
Leadership Style – Working Stages
Roles and functions
© D
avid W. B
utler 2009
Functions
Leadership Style – Working Stages
Skills
© D
avid W. B
utler 2009
StyleSlightly more
directiveTeacher
Leadership Style – Later Stages
Roles and functions
© D
avid W. B
utler 2009
Techniques and procedures
© D
avid W. B
utler 2009
RaceEthnicityAgeReligion / spiritual tradition
ethical/value issues
© D
avid W. B
utler 2009
General Evaluation of the empirical
evidence critiquing the strengths and limitations of the integrative approach
Humanistic therapies underrepresented in empirical studies, especially as compared with cognitive and/or behavioral (Klein, 2008)
Cohesiveness may not be as predictive of positive outcomes as previously believed (Hornsey, et al., 2009)
Empirical Evidence
Mindfulness
© D
avid W. B
utler 2009
Plan for developing the necessary competence to lead such a social work group using this integrative theoretical approach
Attend 5-day intensive training program through UMASS Medical School, Oasis Professional Education and Training program in January, if financially feasible
Teacher certification in MBSR by 2012http://www.umassmed.edu/Content.aspx?id=4
4552
Development Plan
© D
avid W. B
utler 2009
Melbourne…Neff, K. D. (2003). The development and validation of a scale
to measure self-compassion. Self and Identity, 2, 223–250.Neff, K. D., Kirkpatric, K. L., Rude, S. S. (2007). Self-
compassion and adaptive psychological functioning. Journal of Research in Personality, 41, 139-154.
Klein, W.H. (2008). Toward the establishment of evidence–based practices in group psychotherapy. International Journal of Group Psychotherapy,58, 441-454.
Segal….Weinstein, N., Brown, K. W., & Ryan, R. M. (2009). A multi-
method examination of the effects of mindfulness on stress attribution, coping, and emotional well-being. Journal of Research in Personality, 43(3), 374-385.
References
© D
avid W. B
utler 2009
Approach of Marina Claessens
adapting to the client and not the other way round.
most significant factor relating to successful outcome is not the therapist’s preferred school of thought, but the relationship between therapist and clients.
establishing an empathic, safe and supportive therapeutic environment
I will guide you towards clarifying what
your aims and objectives are if you need to, and then towards achieving them.
This can be done not just by talking, but also in many cases by a variety of experiential exercises which can bring to awareness those aspects of oneself that cannot be reached by words alone.
Therapy remains at all times a collaborative and creative process.
Inot a question of me telling you what to do but of us working together to explore your current way of making sense of your experience.
This is done in order to identify how your problems may have originated, how they are maintained, the function they may serve and the best way for you to challenge them.
© D
avid W. B
utler 2009
AnxietyBeing
Existential
“man is, before all else, something which propels itself towards a future and is aware that it is doing so”. Sartre
© D
avid W. B
utler 2009
The PPT presentation will include:
(1) Key concepts of the approach;
(2) Role and function of the social work group leader at the various stages of group development;
(3) Application of social work skills including the use of various therapeutic techniques and procedures;
(4) Discussion of ethical/value issues and the application of the integrative approach to multicultural populations;
(5) Evaluation of the empirical evidence critiquing the strengths and limitations of the integrative approach, and a
(6) Plan for developing the necessary competence to lead such a social work group using this integrative theoretical approach.