Cognitive Theory Clinical Social Work Practice

1. How does this theory fit with a clinical social work perspective?
Continuous concern with the individual in-situation is often regarded as social work’s most unique or distinguishing feature. In spite of the debate on where emphasis should be placed, both internal psychodynamics and environmental determinism are regarded as important for proper social work practice. Recent contributions made to the theoretical groundwork by cognitive-behavioral studies show that both needs can be dealt with simultaneously. Social work practice is anchored on the important, perhaps pivotal, notion that overall human behavior is usually the sum of both environmental and personal realities. Though yet to be developed thoroughly into a formal and widely accepted paradigm, the cognitive learning perspective draws from several perspectives including clinical experience, behaviorism, and cognitive psychology (Berlin, 1987).
According to the Code of Ethics published by the National Association of Social Workers (1996), there is a need to respect and appreciate the significance of human connection and, therefore, a need for social workers to engage with clients on that level and as partners. From the time cognitive theory began being adopted, therapeutic relationship was redefined into more of a collaborative effort between a social worker and client - a collaborative effort with emphasis on the relationship and on the active role the client needs to play in the helping process; a collaboration that is anchored on two rights of the client: the right to make their own choices with regards to the treatment process and the right of self-determination. In other words, a collaboration that is focused on empowering the client and using their strengths in the helping process. Both client empowerment and use of the client’s strength are now crucial in social work practice. With regards to cognitive theory, cooperation or collaboration between a social worker and client helps to reinforce human connection/relationships, and is actually reinforced in every individual phase of the helping process (Gonzalez-Prendes, 2012).
2. Provide a theory driven problem statement and assessment of the client system in the environment.
Problem statement: If the client (Mr. Jackson) lacks personal strength (as shown by his physical weakness, chronic depression, and cognitive impairment) as well as environmental resources (as exhibited by his few friends, lack of children, frail wife, and minimal pension), he risks disorganization, deterioration, and disorientation. In this case, a directive and active social worker should immediately dedicate time to being an extra or critical resource for the client when needed. In contrast, if the client has strong environmental resources and personal strengths (D), the social worker should probably only limit his/her activities to emotional support, offering suggestions, and direct referrals. If the client’s environmental resources are strong but their personal resources are limited (B), the activities of the social worker ought to be concentrated on searching for network and organizational resources to provide to the client, and helping them compensate for their limited personal strengths. Lastly, if the client has limited environmental resources but sufficient personal strengths (C), the activities of the social worker should be focused on assisting him/her in finding alternative external resources. By helping clients to compensate for what they lack in, social workers can provide much-needed improvement in the client's situation (Gitterman & Heller, 2011).
3. Consider and thoroughly discuss the key theoretical concepts of the theory.
Self-efficiency
This is a concept first mentioned by Bandura and it simply describes an individual’s belief in their own capacity to implement a certain behavior, together with the self-confidence that an individual possesses to carry out a particular task and achieve the desired results. Central to Bandura’s theory is the Model of Self-Efficacy, which is the process whereby an individual partakes in a certain behavior with the desired subsequent outcome. The model starts with the awareness of a problem’s existence, which is then followed by the belief that a desirable outcome can be achieved through the individual’s actions, thereby creating the impetus to persist (Adefolalu, 2018).
Mastery of performance
This describes the skills and knowledge acquired via experience and persistence (Bandura, 1998). This particular strategy can be applied in ART (anti-retroviral therapy) adherence, because it involves teaching patients the various ways of escaping negative self-talk and self-defeating thoughts, as well as of substituting them with task-oriented ones in order to avoid lack of hope linked to adherence to ART.
Vicarious experience
This happens when an individual sees other individuals successfully completing a certain task. This acts as a means of modelling self-efficiency for the observer (Bandura, 1988). Modelling or vicarious experience could be utilized in improving ART adherence by counsellors, in the form of vicarious emphasis wherein a desirable behavior like adherence is emphasized by seeing another individual get rewarded for it (Adefolalu, 2018).
Verbal persuasion
Verbal persuasion normally assumes the form of discouragement or encouragement from another individual, and is actually the most frequently used self-efficiency technique by healthcare experts. It is utilized to try to persuade an individual that they could do well at a certain task. Social or verbal persuasion serves to reinforce the feelings of self-efficiency when experiencing small failures linked to ART adherence. Health personnel utilize verbal encouragement and persuasion to improve adherence to ART through showing confidence in their abilities (Adefolalu, 2018).
Physiological symptoms
Physiological symptoms serve as information sources pertaining to a person’s self-assessment of competence. An individual’s physical reaction to challenging situations could affect their level of preparedness to effectively deal with the situation (Bandura, 1998). In stressful situations, an individual’s thoughts on the effect of their own suffering could alter their self-efficiency. Getting overwhelmed when experiencing various difficulties linked to chronic health conditions can be construed by an individual with low self-efficiency to be an indication of their incapacity to stick to treatment, hence lowering self-efficiency even further. An individual with high self-efficiency will, on the other hand, construe such symptoms as normal and not related to their capacity to stick to treatment. According to research, it is an individual’s belief in the effects of physical signs that alter self-efficiency (Adefolalu, 2018).
Reinforcement
This concept underlies and predates a lot of what is found in social cognitive theory, which is more straightforward on how behavioral tactics actually work. Here, response to behavior could determine whether or not that particular behavior is going to be repeated. Reinforcement can be negative or positive. When healthy behavior gets reinforced, it is more likely that the person will repeat that behavior. Negative reinforcement or lack of response to an individual’s behavior makes repetition of such behavior less likely or unlikely (Adefolalu, 2018).
Outcome expectation
This is the belief that certain behaviors will lead to a particular effect or outcome, which could either be negative or positive. Cognitive theory assumes that one will go for an action that they believe will minimize negative results and maximize positive results. Cognitive intervention among ART patients is focused on altering the patient’s attitude and behavior by helping them to change unrealistic behaviors or expectations (Adefolalu, 2018).
4. Formulate a beginning intervention plan that includes goals, strategies to help alleviate the problem (s) and criteria that you and the client system will use to determine whether the problem is resolved. Consider the ethical and value dilemmas that may present as you plan your intervention.
SCT Construct
Objectives
Strategies
Behavioral Capability
Skills and knowledge to carry out physical activity
An understanding of the intensity and duration of the physical activity required for medical benefits
What the terms 'physical activity' and 'exercise' refer to
An understanding of what activities make up physical activity or exercise
Outcome Expectations
Values, beliefs and expected results of engaging in regular physical activity
Advantages of physical activity
Value placed on physical activity benefits
Why patients would like to engage in physical activity
Self-efficiency
Confidence in one’s ability to overcome obstacles and engage in physical activity
Past experiences relating to physical activity
Obstacles to physical activity
Strategies on how to deal with obstacles
Physical activity that African Americans like to perform
Self-regulation
Capacity to manage exercise and physical activity behaviors via goal setting, self-rewards, and self-monitoring
Connotations and general feelings linked to the phrases “physical activity” and “exercise”
Suggestions for how African American females could include physical activity in their daily schedule
Goal-setting and self-monitoring
Reinforcements or rewards for physical activity
Social Support
Degree to which important referents (peers, friends, and family) influence, approve, and/or encourage the performance of physical activity
Social support sources for physical activity
How to locate social support for physical activity
How to include social support in a physical activity program
(Rodney, Ainsworth, Mathis, Hooker, & Keller, 2017)
4b. Interventions utilized under theoretical framework
According to Parks and Biswas-Diener (2013), positive interventions are normally conceptualized broadly as: (1) Interventions engineered to promote wellness, instead of working on weaknesses, (2) Interventions targeting positive outcomes or utilizing a positive mechanism, and (3) Interventions that put an emphasis on positive topics. The authors further pointed out in their work that positive interventions aim at building positive variables such as meaning, positive emotions, or SWB, and that there ought to be empirical evidence indicating that an intervention is targeting or manipulating a target variable or variables, as well as evidence that the target variable(s) are being improved. Although researchers have formulated a sound definition for positive interventions, they seem to miss out on the key role played by both theory and evidence. Regardless, it is a definition that is key to this section of the paper. The two researchers group positive interventions into seven categories: empathy, savoring, meaning, social connections, forgiveness, gratitude, and strengths. Other researchers, including Neville (2014), have also similarly categorized positive psychological interventions.
Major Existing Positive Interventions
Building Positive Emotions and Pleasure
Gratitude: The recognition of the occurrence of something positive and awareness that another party is responsible for it.
Loving-kindness meditation: Extension of warmth and affection towards others for their presence and help.
Savoring: Tasting and enjoying positive or pleasurable moments for as long as is possible (Nevill, 2014).
Building Engagement
Flow and mastery: Balancing skills and challenges in a way that creates a feeling of competence and mastery.
Social connections: Actively engaging others, including friends and strangers, and working with them towards mutual benefits.
Signature strengths: Utilizing one’s strengths in every way to achieve goals and objectives.
Building Meaning and Purpose
Expressive writing: Creating a meaningful and coherent narrative to help improve oneself and to better achieve goals.
Reminiscing: Pondering over positive past memories for greater satisfaction in life and emotional experiences (Nevill, 2014).
When these interventions are considered collectively together with their related actual exercises, they provide a number of insights: First, they share a common element of focused awareness, which is the activation of mindfulness and cultivation of the same for positive experiences or existence. Second, the interventions do not seem to have a theoretical basis. The recommended interventions and exercises are broadly standalone activities developed to provide empirical support. Lastly, a common definition of positive interventions cannot easily be derived from the interventions even though they all somewhat match the definition given by Parks and Biswas-Diener (2013).
Pawelski (2009) utilizes five elements to describe positive interventions. The five elements include the activity itself, the active ingredient, the target system, the targeted change, and the desired outcome. To develop a positive intervention, there is a need to first establish a goal or desired outcome, and then to conversely develop the activity (or intervention) that will lead to it. So it is through working backwards that interventions can be built. Even though Pawelski does not define positive interventions, how he conceptualizes them is both parsimonious and heuristic.
Bibliography
Adefolalu, A. O. (2018). Cognitive-behavioural theories and adherence: Application and relevance in antiretroviral therapy. South Afr J HIV Med., 762.
Bandura A. Organizational applications of social cognitive theory. Aust J Manage. 1988;13(2):275–302. https://doi.org/10.1177/031289628801300210 [Google Scholar]
Berlin, S. B. (1987). Cognitive behavioral interventions for social work practice. National Association of Social Workers, Inc.
Gitterman, A., & Heller, N. (2011). Integrating Social Work Perspectives and Models with Concepts, Methods and Skills with Other Professions’ Specialized Approaches. Clinical Social Work Journal, 204-211.
Gonzalez-Prendes, A. (2012). Cognitive-behavioral practice and social work values: A critical analysis. Journal of Social Work Values and Ethics.
National Association of Social Workers. (1996). Code of Ethics. Retrieved from http://www.naswdc.org/pubs/code/code.asp.
Nevill, D. (2014). Positive Interventions: Developing a Theoretical Model to Guide Their Development and Use. Master of Applied Positive Psychology (MAPP) Capstone Projects.
Parks, A. C., & Biswas-Diener, R. (2013). Positive interventions: Past, present, and future. In T. Kashdan & J. Ciarrochi (Eds.), Mindfulness, acceptance, and positive psychology: The seven foundations of well-being (pp.140-165). Oakland, CA: New Harbinger Publications
Parks, A. C., Schueller, S. M., & Tasimi, A. (2013). Increasing happiness in the general population: empirically supported self-help? In S. A. David, I. Boniwell, & A. ConleyAyers (Eds.), The Oxford handbook of happiness (pp. 962-977). Oxford, UK: Oxford University Press.
Pawelski, J. O. (2009). Toward a new generation of positive interventions. Manuscript in preparation
Rodney, J., Ainsworth, B., Mathis, L., Hooker, S., & Keller, C. (2017). Utility of Social Cognitive Theory in Intervention Design for Promoting Physical Activity among African-American Women: A Qualitative Study. Am J Health Behav., 518–533.