This book provides the foundations and training that social workers need to master cognitive behavior therapy (CBT). CBT is based on several principles namely cognitions affect behavior and emotion; certain experiences can evoke cognitions, explanation, and attributions about that situation; cognitions may be made aware, monitored, and altered; desired emotional and behavioral change can be achieved through cognitive change. CBT employs a number of distinct and unique therapeutic strategies in its practice. As the human services increasingly develop robust evidence regarding the effectiveness of various psychosocial treatments for various clinical disorders and life problems, it becomes increasingly incumbent upon individual practitioners to become proficient in, and to provide, as first choice treatments, these various forms of evidence-based practice. It is also increasingly evident that CBT and practice represents a strongly supported approach to social work education and practice. The book covers the most common disorders encountered when working with adults, children, families, and couples including: anxiety disorders, depression, personality disorder, sexual and physical abuse, substance misuse, grief and bereavement, and eating disorders. Clinical social workers have an opportunity to position themselves at the forefront of historic, philosophical change in 21st-century medicine. While studies using the most advanced medical technology show the impact of emotional suffering on physical disease, other studies using the same technology are demonstrating CBT’s effectiveness in relieving not just emotional suffering but physical suffering among medically ill patients.
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When Charles, a 46-year-old divorced male with an extensive psychiatric history of depression, substance abuse, and disordered eating resulting in a suicide attempt, erratic employment, and two failed marriages, began treatment with a clinical social worker trained in dialectical behavior therapy (DBT), he was an angry, dysphoric individual beginning yet another cycle of destructive behavior. This chapter provides the reader with an overview of the standard DBT model as developed by Linehan. Dialectical behavior therapy, which engages vulnerable individuals early in its treatment cycle by acknowledging suffering and the intensity of the biosocial forces to be overcome and then attending to resulting symptoms, appears to be the model most congruent with and responsive to the cumulative scientific and theoretical research indicating the need for the development of self-regulatory abilities prior to discussions of traumatic material or deeply held schema.
This chapter includes scripts for Eye Movement Desensitization and Reprocessing (EMDR) treatment of clients with cancer, eating disorders, headaches, somatic disorders, sexual disorders, and more. It also includes summary sheets for each protocol to facilitate gathering information, client documentation, and quick retrieval of salient information while formulating a treatment plan. The treatment of chronic pain is a new and growing application of EMDR. The suitability of EMDR for chronic pain stems from a number of sources. There are similarities and overlaps between traumatic stress and physical pain that would suggest EMDR as an appropriate addition to working with chronic pain. Negative Cognition (NC) is optional when the pain is not related to trauma. If possible, the NC will elicit clients’ attitudes or beliefs about themselves around their pain. Positive Cognition (PC) is about how clients would like to feel about themselves in relation to their pain.
This chapter explores ways to talk with clients of all ages whose lives have been intruded upon by dangerous habits such as substance abuse, eating disorders, self-harm, and obsessive-compulsive disorders (OCD). The assumption of a therapist using solution focused narrative therapy (SFNT) is that the client’s attempt to cope with situations in his or her life has led to habits and activities that have become dangerous to the client’s well-being and possibly others in his or her life. The therapist therefore does not confront the client, but rather seeks best hopes from the client regarding what the client wants to better in his or her life. It is the hope of the therapist that by working with the client to achieve what the client wants, he or she will see a need to give up the habit and feel empowered to create a preferred future.
Many individuals with eating disorders will not self-refer for treatment or seek an evaluation; therefore, the ability of friends, family, and others to recognize signs and symptoms of an eating disorder is crucial. This chapter discusses the role various individuals can play in the identification and referral of someone suspected of having an eating disorder, what happens after a referral is made, and what can be done to increase the chances that an individual will follow-through on a referral. Educators and other school personnel are also in a position to be among the first to know about or to be informed about a problem that may indicate the presence of an eating disorder. In many cases, athletes may be more at risk for developing an eating disorder than the general population. Although work itself is not necessarily a cause of an eating disorder, job-related stress may exacerbate eating disorder symptoms.
The process of screening is typically a much briefer process than that which is involved in an assessment process. With regards to eating disorders specifically, there are multiple screening tools that can be used to help determine if someone shows signs of an eating disorder, thereby warranting a more formal assessment. Likewise, there are multiple assessment tools designed to confirm the diagnosis, determine the severity of the symptoms, and help inform the type and mode of treatment. This chapter briefly summarizes some commonly used screening and assessment tools for eating disorders. The SCOFF screening tool is one of the briefest screening tools for eating disorders and is commonly used. A thorough evaluation includes a medical assessment, psychological assessment, nutritional assessment, and family assessment. Each can provide invaluable information that can aid in the diagnosis and treatment of someone with an eating disorder.
This chapter presents general signs that an eating disorder may be present. It discusses in detail the signs and symptoms of specific eating disorders such as anorexia nervosa; bulimia nervosa; and binge eating disorder. The chapter presents each specific eating disorder in terms of the signs that may signal that particular disorder followed by a description of diagnostic symptoms that are indicative of that disorder. It looks at what may be an indicator that an eating disorder of some kind may be developing or has already developed. Emotional signs of an eating disorder can involve specific changes in emotions, the expression of particular emotions, or the experience of things that can negatively impact someone's emotions. In addition to emotional and behavioral signs, there are many physical signs indicative of an eating disorder that can affect potentially every system in one's body.
Eating disorders are complex and difficult to treat. One of the most significant reasons for difficulty with respect to treatment is not only the degree to which these disorders can be life threatening, but perhaps more significantly, the degree to which the eating disorder fights tooth and nail to ensure its survival. Strong emotional reactions, often referred to as countertransference reactions, to patients with an eating disorder are common and can range from care and concern to frustration and rage. Acknowledging and identifying one's own countertransference reactions can help both the person feeling them and the patient as well. This is particularly true for treatment providers who can risk harm to themselves and/or the patient if countertransference reactions remain unidentified. By contrast, when countertransference reactions are identified and appropriately understood the treatment provider may learn more about himself or herself as well as the patient, which ultimately can benefit treatment.
This concluding chapter of the book presents several scenarios that are designed to illustrate for the reader what an eating disorder might "look like" in the real world and what initial treatment efforts might entail. The first scenario is about a 10-year-old elementary school student who throws food away at lunch. The second scenario is about a 14-year-old freshman in high school whose weight puts him in the body mass index (BMI) category of obese. The third scenario is about a 19-year-old college student who had a long-standing history of eating disorders. The fourth scenario is about a 55-year-old married mother who dieted extensively in her teens and early adulthood. The fifth scenario is about a 20-year-old competitive collegiate student-athlete. The final scenario is about an 18-year-old high school wrestler.
This book primarily benefits those who do not know a lot about eating disorders or who have not had any formal education with respect to the complexities of these disorders. This book is organized into several parts designed to address different aspects of eating disorders. The part I describes what eating disorders are and who develops them, including a brief history as well as signs and symptoms of the disorders, and who is likely or less likely to develop an eating disorder. Part II of the book describes factors that can be considered risk factors, co-occurring factors, or consequences of having an eating disorder. These factors are discussed in terms of whether they are biological or medical, psychological, interpersonal, or sociocultural in nature. The part III guides the reader through how to identify those who might be at risk for developing an eating disorder and how to effectively refer someone for an evaluation. This section includes a discussion of what types of professionals should be part of treating someone with an eating disorder and important sources of support who should be involved in the treatment process or kept informed about how treatment is progressing. The part IV describes prevention and treatment efforts commonly used and a brief overview of their effectiveness. It also includes a chapter on identifying and managing one's own emotional reactions to someone with an eating disorder. Finally, the book concludes with several scenarios designed to illustrate for the reader what an eating disorder might "look like" in the real world and what initial treatment efforts might entail.