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CREATING A REFUGE: CLINICAL CASE MANAGEMENT WITH FAMILIES

CREATING A REFUGE: CLINICAL CASE MANAGEMENT WITH FAMILIES. Clinical Case Management With Families. Takes a both and approach to the seeming duality of different models of change and different types of change First order change – ex. medical model Second Order Change – ex. recovery mode

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CREATING A REFUGE: CLINICAL CASE MANAGEMENT WITH FAMILIES

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  1. CREATING A REFUGE: CLINICAL CASE MANAGEMENT WITH FAMILIES

  2. Clinical Case Management With Families • Takes a both and approach to the seeming duality of different models of change and different types of change • First order change – ex. medical model • Second Order Change – ex. recovery mode lWatzlawick, Weakland & Fish. (1974). Change: Principle of Problems Formation and Problem Resolution. W.W. Norton

  3. Winnicott’s Definition of Casework • Casework might be described as the professional aspect of this normal function of parents and of local social units, a ‘holding’ of persons and of situations, while growth tendencies are given a chance. These growth tendencies are present all the time in every individual, except where hopelessness … has led to an organized withdrawal. These tendencies have been described in terms of integration, of the psyche coming to terms with the body, the one becoming linked to the other. (1961, p.107).

  4. Clinical Case Management With Families • What is therapeutic involves both first order and second order change. • What is therapeutic involves attention to both symptoms and tangible needs as well as attention to attachments and re-connection.

  5. Assessment: What Type Of Change Is Needed? • First order changes are measurable, observable and amenable to quantitative methods. • Ex: Symptoms, tangible needs • Second order changes are subjective and are amenable to qualitative methods • Ex: Spirituality, values, beliefs

  6. Assessment: Refuge or War Zone?How safe is the family? The Crisis Chain • Stage # 1 More of the same • Stage # 2 Seek help • Stage # 3 Inversion of values • Stage # 4 Ritual suicide • Stage # 5 Family in runaway David, Kantor & William Lehr. (1975) Inside the Family. Jossey-Bass

  7. CRISIS CHAIN MORE OF THESAME GET HELP INVERSION VIOLENCE = LOVE HELP = ENABLE GOOD = BAD RITUAL SUICIDE RUN AWAY

  8. BEFORE The home is a bunker. There is a hierarchical difference between the partners. Their embarrassment contributes to rigid closed boundaries between themselves and the world AFTER The home is a refuge. The hierarchical differences have been eliminated and the boundaries between the couple and the outside world and more open. MattieBystander Ron Victim Mattie-Ron Ron and Mattie

  9. ALLAN AND BRANDY REFUGE GET HELP INVERSION VIOLENCE = LOVE HELP = ENABLE GOOD = BAD COMBAT RUN AWAY

  10. References • Kantor, D., Lehr, W. (1975). Inside the Family. San Francisco, CA: Jossey-Bass • Winnicott, D.W. (1961) “Varieties of psychotherapy.” A talk given to Mental Illness Association Social and Medical Aspects, Cambridge 6 March 1961. In Winnicott, C., Sheperd, R., Davis, M., (Eds). (1986). Home is where we start from. New York: W.W. Norton.

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