I passed!

I am happy to report that I passed the LICSW with flying colors! I apologize for not posting sooner -- I am glad a comment was made on the blog which reminded me to post an update. The test seems like one of those things that you obsess about for so long that after it's over you just want to forget about it and move on!

Firstly, the server crashed at my site so my test was delayed by a day. Talk about a let down! To have all that adrenaline pulsing and to feel ready to just get it over with and then to find out you can't. Not to mention postponing the celebratory drinks at my husband's holiday party that night :( However, I have to say the staff at the testing site were extremely apologetic and helpful in getting us all rescheduled.

The next day I returned, feeling glad that at least I had done a "practice run" (i.e. how to get there, where to park, layout of the site). The actual exam wasn't too bad. I think one key point to remember is to acknowledge feelings and build rapport first. Frankly, I began to second guess myself because it seemed like there were 20 questions related to this.

There were only 2 questions on the test where I had NO CLUE! I basically had to guess. Many questions I knew right away I found it helpful to use tips from the LICSW Review course that I took through the Washington NASW chapter (hierarchy of needs, build rapport/acknowledge feelings, rule out medical issues). I only had one medication question, so I over prepared in that area. I flagged more than I thought I would (maybe 30 or 35) and went back to review only the flagged questions. As 3 hours approached I was mulling over the flagged questions and just second guessing myself so I took a deep breath and hit "QUIT".

My coworker told me that when you hit quit, the screen goes blank and then a "You passed" screen with the score pops up. This did not happen for me -- instead it asked me to take a short survey about my testing experience. I immediately feared that I had failed and they wanted to survey me to see why. Silly, I know, but they literally hold you hostage and make you go through a 10 question survey before you get your score. I personally don't find it a very ethical survey since you cannot opt out -- but once it was over I got the "You passed" screen and I was relieved to put it all behind me.

Hope this was helpful and good luck to all of you out there!

Day before test jitters!

While I have not posted in quite a long time I assure you Ihave been studying. I have spent a significant amount of time going back over the ASWB study guide, using their online practice test (and reviewing it's rationales) and studying the handouts from the Washington NASW Licensure Review course.

As the day of reckoning quickly approaches I am trying to keep in mind what I think will be the most pertinent points to guide my reasoning and application on the test.

• Licensure is mostly to protect the consumer, use that to guide your answers
• Safety of the client/family/public first (always choose the answer that protects)
• Always rule out a medical condition first when given assessment options
• Pay attention to qualifiers or buzz words (Most, First, Least, Next)
• Choose the answer that directly relates back to the patient's presenting problem when given multiple plausible intervention choices
• Respond to the item as it appears (don't read into it or apply it to a real life situation you have had)
• Don't let your past experience lead you astray! Remember, this is a hypothetical client! They are looking for a textbook answer (not the think outside the box answer)
• If you are unsure, look at the answers, is there one that is clearly different than the other three Example: Enmeshed families often display: a) positive communication b) healthy boundaries c) respect for one another's self determination d) lack of boundaries Obviously 3 of these answers are "healthy" traits and one (lack of boundaries) is not. You could pick the one that is clearly different or mutually exclusive from the others even if you did not know the definition of an enmeshed family.
• Always consider rapport building. Whenever possible acknowledge the clients feelings or statements before moving on.

Hopefully by 2pm tomorrow I will be finished with my LICSW exam with a big smile one my face. Then I can relax, celebrate the holidays and hopefully enjoy some fresh powder in the mountains of Montana! Will keep you posted.

Study and Test Taking Tips

While reviewing some test prep materials my medical center purchased years ago I came across some great tips for studying as well as tips for taking the ASWB exam.

Study Tips:

While using the practice exams from various websites or programs you may purchase or borrow, write down any unfamiliar terms and then look them up in the Social Work Dictionary. This will give definitions specific to the context of social work practice.

When studying think application not memorization! Don't memorize the sample questions, focus on the theory/technique/disorder etc. and the application of this to practice.

Test Taking Tips:

Arrive early, bring ID.

Scan the questions for buzz words like should, first, except, next.

In case examples sort out the important info -- what are they asking? Don't get bogged down in all the minor details of case examples.

Answer each question, flag the ones you are unsure of. Write down the question number and key terms on your scratch paper, return to the question after you have finished.

It is suggested that you do not change any of your answers on the first 70 questions. (probably that whole "first impression is usually right" idea and the fact that you were still mentally fresh during that time)

Pick options in order of how you should proceed - Assess/Discuss/Explore, then Educate, Advocate, Facilitate/Refer, Intervene. For example, in a question about possible child abuse you would not intervene before exploring.

Never choose an option to do nothing.

Always start where the client is.

Try to choose the option that empowers the client to do for themselves whenever possible.

Choose answers that maintain confidentiality whenever possible (exceptions: duty to warn, court order, suicidal with plan/intent).

All major social work models stress psychosocial person in environment/situation focus.

Consider the SW Code of Ethics when answering questions, are you "enhancing human well-being and helping to meet the basic needs of all people particularly the empowerment of people who are vulnerable, oppressed, and living in poverty"?

Our primary ethical responsibility is to clients, over our agency and larger society (except for specific legal obligations such as those mentioned above).

I read on another blog a helpful thought: this test is not necessarily about what you would do in a given situation but what the textbook social worker would do.

Behavior Theory -- the big picture

So, lets back up a bit to the big picture behind Behavior Therapy -- Behavior Theory.

• Behavior Therapy is the application of techniques intended to create behavioral changes that are based on the principles of the conditioning theories of learning.
• These are characterized by multiple theories and techniques.
• The foundation is in Pavlov's classical conditioning, Skinner's operant conditioning and Bandura's Social Learning theaory.
• Skinner: behavior can be empirically investigated only through the measurement of observable behavior
• Withholding reinforcement = extinction
• This paradigm also includes Cognitive Behavior approaches
• All behavior is learned and can be defined and changed
• Change occurs by rearranging "contingencies of reinforcement" - altering what happens before and after the behavior

Social Learning Theory: Comprised of 3 elements

1. Target Behaviors (the target of change)
2. Anticedent behaviors or events (events that precede the behavior)
3. Consequences (events that follow the behavior)

Behavior Therapy Paradigm A-B-C

A (anticentent) ->B (behavior) -> C (consequences)

• In treatment the client(s) must identify DESIRED behaviors not just the undesired

Key Terms

• Coercive Process - negative reinforcement, the termination of a behavior (threats) upon occurrence of the desired behavior (compliance)
• Information processing- acquisition, storage and utilization of information (includes perception, language and memory).
• Beliefs and Belief Systems- ideas attitudes and expectations about self, others and experience
• Self Statements- private monologues that influence behavior and feelings
• Problem solving and coping - conceptual and symbolic processes involved in arriving at effective responses to problematic situations.

Behavioral Social Work Practice: goal is to increase desireable behavior and decrease undesirable behavior so the client can improve daily functioning.

• Focus on the here and now
• Build on client strengths
• Etiology of behavior is not investigated
• Traditionally a diagnostic label was not pursued and thought of as stigmatizing but with current approaches, there is more integration of diagnostic classifications (likely due to requirements from insurance companies)
• Build a strong therapeutic relationship
• Involve the client as much as possible in each step of the assessment/intervention

Assessment steps:

1. Identify problematic behavior (perception of who does what)
2. Identify priorities, antecedents & consequences
3. Identify contingencies
4. Identify recurrent patterns
5. Secure a commitment
6. Begin to identify targets (desireable behaviors)
7. Discuss possible targets
8. Allow time for all family members to present concerns (if applicable)
9. When targets are established, set conditions for a baseline measure
10. Determine if assessment indicates a change, does one or more participants require more attention (i.e. should it be couples therapy rather than family therapy?)

Implementation

1. Identify target behaviors
2. Establish new antecedents
3. Establish new consequences
4. Formulate a written contract
5. Follow up call
6. Reference contract, any changes require a consensus from family/clients
7. Check tally (in families parents usually tally target behaviors) provide positive reinforcement
8. Discuss problems between sessions
9. Conflict resolution
10. Evaluate program design
11. When target behaviors reach desired frequency, move toward termination

Termination

1. Evaluate progress
2. Set conditions for maintenance
3. Review basic learning principles
4. Have family continue tally for 4 weeks
5. Set up appt at 4 weeks for termination and f/u

Summary

• Very helpful for anxiety, depression, phobias, addiction, sexual dysfunction, relationship issues.
• Often paired with systematic desensitization
• Most recommended treatment for Phobic Disorders
• Also indicated for social skills training, hyperactivity, developmental problems
• Interventions must consider cultural issues and differences
• Empirically validated
• Sometimes combined with pharmacotherapy
• Need to maintain a record of what approaches work most effectively with what problems

Adapted from Social Work Treatment by Francis J. Turner, 4th Ed.

Rational Emotive Behavior Therapy

I recently took the practice test that came in the ASWB Clinical Exam study guide and highlighted all of the terms/theories that I needed to brush up on. This led to me researching Rational Emotive Behavior Therapy. The title above links to a great website for the New Zealand Centre for Rational Emotive Behaviour Therapy. (I may be a bit partial to the Kiwis as I am married to one). The basics of REBT are as follows:

Developed by Dr. Albert Ellis in the 1950s, in REBT the focus is on the client's beliefs. REBT is one of many Cognitive Behavioral therapies. REBT proposes a "biopsychosocial" causation of human feelings and behavior. The premise is that almost all emotions and behaviors are a result of what we think, assume or believe (either about ourselves, others or the environment around us). REBT also accepts that a person's biology also plays a part and there are limitations to how much a human being can change. REBT is an "active-directive" therapy.

Ellis used an ABC model to illustrate the role of cognition:

A - the actual event or experience and the persons "inferences" or interpretation of it

B - the "evaluative" beliefs that follow

C - the emotions /behaviors that follow the evaluative beliefs

Example:

A - the waiter did not offer to show me the dessert menu (activating event)

A - the waiter must think I am fat and don't need dessert (inferences)

B - I am disgusting, worthless, I have no self control (evaluation)

C - Feeling depressed, go home and binge on oreos (emotional, behavioral reaction)

This can create a chain reaction where "C" becomes "A" triggering another episode. To achieve lasting change you must modify the underlying core beliefs.

Irrational thinking: a thought that blocks a person from achieving their goals, creates extreme emotions that immobilize and harm oneself and others. It distorts reality (misinterpretation not supported by available evidence). It contains illogical ways of self evaluation and evaluating others. REBT practitioners often refer to beliefs as "self defeating" to highlight that the main reason for replacing the belief is because it is negatively affecting their life.

Ego disturbance: an upset to the self image as a result of holding onto demands about one's self followed by negative self evaluations. (I must do _, When I fail I am worthless). Discomfort disturbance results from demands of others & the environment. This comes as Low frustration tolerance (LFT) demanding that frustration not happen and catastrophising when it does. Also Low discomfort tolerance (LDT) demands that one not experience emotional/physical discomfort and catasrophising when discomfort occurs. LFT & LDT leads to "discomfort anxiety", worrying, avoidance of potentially stressful events/circumstances, secondary disturbance (anxiety about having anxiety), short-range enjoyment (alcohol/food abuse, shopping -- instant gratification), procrastination, negativity and complaining.

People live by "core beliefs" that guide how they react to events. (i.e. I need love and approval from those around me -- I must avoid disapproval). There are three main levels of thinking 1) Inferences 2) evaluations 3) Core beliefs

Other key terms:

Awfulising: exaggerating the consequences of past/present/future events.

People-rating: overgeneralization where a person judges their (or someone else's) entire worth by a specific trait or behavior.

Some "selectively eclectic" Techniques:

Double-standard dispute: If the client has a "should" belief, ask if they would expect someone else (best friend, therapist) to believe the same. Help them to see the double standard.

Catastrophe scale: Have the client place stressful events on a scale amidst other events such as having to do a chore, find a new doctor, divorce, losing a loved one, major earthquake etc.

Devil's advocate/reverse role playing: therapist adopts the clients belief and argues for it.

The "blow-up" technique: ask the client to imagine a fear and then blow it out of proportion until it becomes almost amusing.

Exposure: Prescribing the client engage in a situation (after preparation) that they would usually avoid (speed dating) to test validity of fears, increase tolerance, develop confidence.

Shame attacking: confronting the fear of shame by asking the client to deliberately act in ways that they fear will attract disapproval.

Goals & Process of REBT:

• Creating an awareness of the effect of beliefs/thinking on behavior.
• Highlight relevant beliefs
• Teach the client to dispute/change irrational beliefs -- often using the ABC format and extending it to D (Disputing) and E (new Effect)
• Prescribing homework that actively practices disputing self defeating beliefs, inferences and evaluations.

Adapted from "A Brief Introduction To Rational Emotive Behaviour Therapy" by Wayne Froggatt

Erickson's 8 stages of Psychosocial Development

Main premise: a series of conflicts must be resolved throughout our development so we can attain a healthy personality.

1. Infant (birth to 18mos) Trust vs. Mistrust: learns to trust self, environment
2. Toddler (18mos to 3yrs) Autonomy vs. Shame and Doubt: learns to believe in him/herself
3. Preschool (3 to 5) Initiative vs. Guilt: learns to take initiative in play rather than mimicking
4. Latency State (6 to 12) Industry/Competence vs. Inferiority: learns that he/she is capable and able to accomplish
5. Adolescence (12 to 18) Identity vs. Role Confusion: searches for individuality from environment
6. Young Adult (19 to 40) Intimacy vs. Isolation: searches for meaningful relationships
7. Middle Adult (40 to 65) Generativity/Productivity vs. Self Absorption or Stagnation: search for meaning through intergenerational communication
8. Late Adulthood (65 to death) Ego Integrity vs. Despair: looking back with either feelings of accomplishment or despair

Human Development (Psych 101 ... dusting off the cobwebs)

Development (how we grow)

2 types of development

• Learning (nurture) -- environmental influences


• Maturation (nature) -- genetic/biological influences

Critical Periods: early development periods during which particular experiences are essential.

Stages: organization of behaviors/thoughts during particular early periods of development defined by relatively abrupt change.

Physical Development

1. Infant stage: baby born with reflexes (automatic behavior: startle, sucking). Vision nearsighted, interested in novelty. Smiles at 4-6 weeks in response to faces. Rhythmic "conversations".
2. Adolescence: more myelination of the frontal lobes may allow for improved self control. Biological development - increased hormones, sex organs develop, growth spurt. Intellectual - formal operational (abstract reasoning), independence, questioning.
3. Aging: older adults experience decline in short-term memory and attention. Transition theories - unanticipated, anticipated, non event, chronic hassle. Major Milestones - starting out, marriage or living alone, parenthood, empty nest, midlife crisis, retirement widowhood.

Social Development: Developing how we relate to others

Attachment: emotional connection between infant and caregiver

1. Harlow's monkey studies: showed the fear of unknown fosters attachment. Monkeys preferred soft, cuddly surrogates even if they did not have food. Monkeys raised w/o mothers were socially incompetent, aggressive and unable to raise their own babies.

3 styles of Attachment (Ainsworth)

1. Secure - warm relationship, baby does not fear abandonment
2. Resistant - close relationship, but baby fears abandonment
3. Avoidant - distant relationship, baby/child indifferent to whether mother is present

Socialization: process by which one acquires the patterns of behavior of their society.

Parenting Styles: (parents are one source of socialization)

1. Autocratic: parents strict, rigid, require obedience and conformity
2. Authoritative: reciprocal (most effective): parents are firm but fair, make & enforce rules, allow questions and encouraged appropriate independence
3. Permissive: parents do not make rules or enforce them

More to come!

Adapted from Bar Charts Quick Study Academic: Psychology and Sparkcharts Psychology.

First Post! Narrowing down the area of study

So, as I am preparing for the Washington LICSW exam I have found that
a) It has been a very long time since college/grad school (or it feels that way)
b) There is so much POTENTIAL material for test questions
c) I need direction! Otherwise I surely will study all the things that I will never get a test question about.

Here it is -- after poking around on the ASWB website, the content areas of the test! I am keeping these in mind and using them as a guide.

Human Development 22%
Diversity 6%
Diagnosis and Assessment 16%
Psychotherapy/Clinical Practice 16%
Communication 8%
The Therapeutic Relationship 7%
Professional Values and Ethics 10%
Clinical Supervision, Staff Development 4%
Practice Evaluation, Utilization of Research 1%
Service Delivery 5%
Clinical Practice Management 5%