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Social Work

Ending the Therapeutic Relationship: Creative Termination Activities

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Termination is a highly important part of every therapeutic relationship that should be addressed throughout each stage of the process.  While many adult clients have the ability to easily think back to their experience in therapy, for youth this is often more difficult.  Because of this I like to provide clients with some sort of physical representation of their time in therapy that will help them reflect on their experiences, highlight their strengths, remind them of what they learned and provide them with tools they can use to help prevent regression, and even continue their progress on their own.

These activities let you both reflect on their time in therapy and transition out of services in an engaging way. I’ve also found that using metaphors often helps young clients to better understand termination and makes after-care instructions more salient.  Below are some ideas for creative termination activities that are easily adaptable to fit your clients’ needs. I am not sure of the origins of all of them, so please let me know if there is someone that I should be citing.

Session Trackers

counter

I recently spoke to an intern who was confused when a number of her clients seemed surprised when it came time to terminate, despite her verbal reminders.  It is sometimes helpful for young children to be able to have a visual representation of how many sessions are left, and it can help them better prepare for termination.  One way to do this is to create a session-tracking chart.  In the examples above clients color in one image, or choose a sticker, at the end of each session.  The activity is quick and also provides a good opportunity for therapists to check-in with clients and help process any feelings surrounding termination that come up throughout the process.

Ready to Set Sail: Termination Activity

sailing off

By Jodi Smith, LCSW, RPT-S at “Play is Powerful”

Supplies: Toy boat, paper boat, paper mache boat, box with a boat drawn on it, etc.

Directions:

  • I’ve found that the use of metaphors increases the amount of information that clients retain and internalize so I use them frequently in termination.  Start by explaining to the client that because of the progress they have made they are ready to sail off on their own.
  • Reflect on what that feels like and process any anxiety, and transition into talking about all the things they will “take” with them to help with their journey.
  • Have the client answer each question and write their response on the back of the cards.  The boat will contain cards related to tools they will take with them (supports, coping skills, etc.), things that may get in their way and strengths (as identified by the client and therapist).  Along with my pre-made cards, I also give them blank ones.

Treasure Chest Termination Activity

treasure

Supplies: Treasure box (Michaels Crafts has wooden “treasure” boxes  that are cheap and easy to decorate.  A link to directions on how to make a paper one can be found here; Stick-on plastic jewels (found at crafts stores, oriental trading co., etc.); Small note cards (cut to fit the box); Pen.

Directions: First, have your client decorate a treasure chest.  Then stick a jewel to each card as your client writes down the “task” that is assigned to that specific color (see below).  On the back of the card they include a specific example of how what they identified has helped them in the past and/or how it will help them in the future.  Below are examples of possible color codes, but you should change them to meet your client’s specific age and needs.  In the end the chest will be full with a stack of jeweled cards.

  • Blue: Strengths (Identified by both the client and therapist)
  • Red: Coping skills
  • Green: Supportive people in their life
  • Orange: Resources from therapist (ex. hotline numbers, therapist referrals or directions for reenrolling in services.)
  • Purple: Self-care activities
  • Pink: Inspiration (future goals, motivational quotes, etc.)
  • Yellow: Things they have learned in therapy

 Suitcase Termination Activity

suitcase

At termination, your client is finally ready to continue their journey on their own.  Even though they will be leaving you behind, they can pack up everything that they have learned during their time with you to take with them.  This metaphor is easy for most people to identify with and it is a fun activity.

Supplies: Plastic or cardboard suitcase; Blank sticker labels; Paper luggage tag; String; Cards; Travel stickers.

Goals: Process termination; Provide transitional object; Help prevent regression; Identify accomplishments, goals, coping tools, etc.

Directions:

  • Have your client make and/or decorate their suitcase.
  • Then they write something they will “take with them” from their time in therapy on each card provided (I print cards with travel clip-art on the back).  This can be things they have learned, coping skills, supports, resources etc.
  • You can also integrate this with the after-care kit I posted.
  • On the labels they write or draw goals they have accomplished.  (Like the old suitcases in movies that are covered with stickers of past travels).  I also provide additional travel stickers.
  • On the luggage tag they write where they are going next.  This could be a new life stage (ex. my 8th graders usually write “high school”) or a goal they would like to accomplish that the contents of the box will help them achieve on their own.
  • Process feelings about termination throughout the activity.

Therapeutic Goodbye Cards

letter

This is such a simple, yet powerful termination activity.  I got this idea from a client who gave me a very touching thank you note during our last session.  It is something I have kept and reflect back on, and i realized that it could potentially play a similar role for a client.

  • The focus of the content is on the journey through therapy and what has been accomplished.  I highlight strengths, review coping tools and lessons learned, and express my thoughts about termination. At the end I usually include instructions of what to do if they decide to enter therapy again.  You could also have the client write a letter to their future self that they can read when they are struggling.

Summer Bucket List

summer

I put a therapeutic twist on this summer craft.  Most school therapists are unable to see clients throughout the summer but may pick up treatment again during the following school year, which is not ideal.  This activity can help encourage adherence to after-care recommendations.

Directions: Have your client design a bucket that will help them to continue your work together on their own and prevent regression.  On the back of the paper bucket they can write goals for the summer, self-care activities, etc.  For the 3D buckets these can go on cards placed inside the bucket.  On the shovel they write down “tools” that will help them to accomplish their goals (social supports, coping skills, resources, etc.)

You’ve Got Mail: Group Termination Activity

mailbox

Directions: First, have your clients create their own paper mailbox.  Then, each person, including the therapist, writes a short note to every other member of the group.  You can instruct them to write something that they have gained by knowing that person, a strength they can identify in that person, a motivating message, etc.  The notes are then placed in the mailboxes for the group members to take home.

Graduation 

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Certificates are very simple to create in programs like Word, Pages, etc. and are a good wrap-up for clients who have worked hard to meet their therapeutic goals.  In my example I left space to write specifics about progress, accomplishments, reflection, etc.  One the last group session we have a “graduation party” where we have fun, reflect on our time together/progress made and process termination.  They are then presented with their certificate.

The Creative Social Worker is a child and adolescent mental health therapist with special interests in trauma, play therapy and school social work. Her blog is dedicated to sharing interventions, resources, and activities with mental health professionals, as well as raising awareness about the social work field and assisting prospective MSW students with graduate school applications.

11 Comments
Beth Crane Palumbo says:

Terrific activities! Thanks for sharing!

After spending 7.5 years in therapy myself -initially catapulted by crisis, then choosing to remain for personal growth- our closure was great. So, in this respect, I was blessed.

Jamie Dvorak Jamie Dvorak says:

Lori Anne Lanski Chris Thompson Angie Mk

Travis Lloyd Travis Lloyd says:

Such a great practical tool!

Candace Sims Candace Sims says:

We talked about this in our clinical meeting brainstorming on ideas due to clients being discharged from court and not having a planned discharge

What a great resource!

Renee Fesser Renee Fesser says:

Good lessons the end is just as important as the beginning.

Really great piece by on creative ways of ending therapeutic relationships with children http://t.co/kGbTnpwrd0 #socialwork

Disability

Moving Beyond “Fixing” People: Social Work Practice with People with Disabilities

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Working on a boarding high-school campus, I have the opportunity to be exposed to different students. During my first year, one student, in particular, stood out. J.M. was a breakout basketball star and had dreams of going to the N.B.A.

Unfortunately, in his junior year, he was in a terrible car accident and as a result was paralyzed from the waist down. Everyone on campus was affected by his accident because J.M. was such a bright presence on campus and when he came back, he was a different person. He was less interactive on campus and lost his love for basketball.

The adults who were working with him every day were so fixated on the medical model, they wanted to “fix” him as much as they could so he could be ‘normal’ again. They suggested to his mom to take him to the best doctors who specialize helping people who are paraplegic learn to walk through virtual reality. They were not focused on his direct needs because they did not ask him, and that was detrimental to his recovery.

In using the social-model informed practice, the adults working with J.M. should have discussed with him how he saw his recovery going. By placing the focus on him rather than his disability, J.M.’s confidence in recovering could have been more positive than negative. Indeed, disability studies scholar Tom Shakespeare discusses the importance of focusing on the individual and not the impairment in order to create a confident space.

One of the limits in the social model approach, Shakespeare says, is the idea that individuals with disabilities should disregard their impairments. More specifically, the social model disavows both individual and medical approaches so much that it actually risks the suggestion that impairments are not the problem!

The medical model is helpful when we are utilizing action practices that are suggested by the person with the disability and not the people around them who are looking at it like a problem that needs to be corrected. As social workers, it will only benefit the clients we are working with if we are their advocates and find a balance between the medical model and the social model.

This essay was originally prepared for Dr. Elspeth Slayter’s social work practice with people with disabilities course at Salem State University’s School of Social Work  Graduate students were asked to reflect on the ways in which they approach their work with clients with disabilities. Specifically, they were asked to reflect on what aspects of their practice were “under” the medical model of disability and which were “under” the social model of disability.

Students were first introduced to the medical model of disability, in which the person’s impairment was the focus. Then, students were introduced to the social model of disability, in which society is seen as the disabling factor as opposed to the part of the person with the impairment. In order to begin to re-visualize what social work practice with a client with a disability would look like, students were asked to answer the following question:

“How can social workers approach the needs of people with disabilities without perpetuating the negative impacts associated with the medical model of disability? Provide a case example and then describe how you could/do/would engage in medical model-informed practice and social model-informed practice with that client.”

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Environmental Justice

Environmental Social Work: A Call to Action

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Photo Credit: United Church of Christ

What is environmental justice? Dr. Robert Bullard, often called the father of the environmental justice movement, in an interview with the Union of Concerned Scientists described it as environmental justice centers on fairness, equity, and particularly racial justice. For decades, the movement has worked to make sure that all communities—especially communities of color and low-income communities—are given equal protection. We have environmental laws on the books in the United States, but they’re often not applied and enforced equally.

It isn’t difficult to believe that the poorest get the worst – that the most vulnerable populations are exploited. But it is not as easy to identify ways that social workers can advance environmental justice and I have been asked several times how specifically social work can play a role in the environmental movement. This article attempts to clarify social work roles in addressing environmental injustice.

In 2011, I published a piece on Environmentalism & Social Work and the importance of social work adopting environmental priorities has only become clearer since that time. Many students have expressed an interest infusing environmental concerns into their work. Instead of viewing a person in the environment, they find it equally important to view the environment in the person.  Environmental social work sometimes referred to as ecosocial work is different from ‘regular’ social work in that it takes an ‘ecocentric’ instead of a people-centric view. The ecosystem is at the core of practice rather than the person.

The American Academy of Social Work and Social Welfare proposed 12 Grand Challenges for our profession. All of these challenges will become worse if we don’t give priority to this one:  “Create social responses to a changing environment”

The Academy goes on to illuminate this challenge: The environmental challenges reshaping contemporary societies pose profound risks to human well-being, particularly for marginalized communities. Climate change and urban development threaten health, undermine coping, and deepen existing social and environmental inequities. A changing global environment requires transformative social responses: new partnerships, deep engagement with local communities, and innovations to strengthen individual and collective assets.

Historically, the profession of Social Work has been slow to embrace remediating environmental injustice as in the scope of our practice. Fortunately, there has been a burgeoning social work literature on the subject. A 2017 content analysis of the literature published in the British Journal of Social Work identified three themes for social workers to explore in ecosocial work:

Creatively apply existing skills to environmental concepts and openness to different values and ways of being or doing

Shift practice, theory and values to incorporate the natural environment: This shift implies a move to ecocentrism with the core value being that all beings have equal access to safe and clean environments. This aspect suggests using social work skills such as empowerment, team-building, community development, management, anti-oppressive practice, holistic interventions, and advocacy to address and mitigate environmental destruction. As first responders, social workers often respond to the community aftermath of natural disasters, but ecosocial work calls for us to be more proactive and preventative in our actions to prevent environmental deterioration and disaster.

Learn from spirituality and indigenous cultures: Appreciating cultural diversity is a given principle in social work practice and in ecocentric social work valuing and using the wisdom of native and tribal cultures is prioritized. Acknowledging the interconnectedness of all life is paramount. How can people live in harmony with the environment?  How can social workers ensure sustainable environments for the physical and emotional well-being of inhabitants? Concepts of transpersonal theory would be helpful in individual and group interventions.

Incorporate the natural environment in social work education: The increasing literature suggests that social workers have a base from which to study the subject. Some schools of social work have adopted concentrations in community sustainability and environmental justice.

Appreciate the instrumental and innate value of non-human life: The concept of biosphere and biofilia are emphasized in ecosocial work. Looking to the natural environment for restorative and transcendent experiences are emphasized.  The premise of adventure-based programs and animal-assisted therapy are certainly reflective of this concept.

Adopt a renewed stance to a change orientation

Change society: Social workers are charged with being “change agents” yet the change required to ensure environmental safety is too often neglected. Valuing environmental and ecological justice should be the driver for change. Advocacy and legislative initiatives that aim for ameliorating environmental injustice are necessary. For example, supporting fair districting and elimination of gerrymandering enables marginalized populations to have a vote that counts.

Critique hegemony: Challenging the social construction of dominance by a particular class calls for radical thinking and action. Anti-oppressive practice demands we examine the political architecture that maintains power and control over people and environment instead of protecting people and environment.  In the previous administration, the EPA asked for social work input on pending regulations. The current administration calls for less regulation and elimination of the agency that is charged with protecting the environment. Challenging the political structure to further progressive environmental causes is necessary.  The foundational core of the Green Party, popular in Europe, and increasingly so in the US, is environmental justice.

Work across boundaries and in multiples spaces

Expanding our usual scope of practice to educate, mobilize, and support community activism is at the core of this theme. Developing partnerships and coalitions demonstrates work across boundaries. Coalitions with public health organizations address toxic environments. Dual degrees such as the MSW/MPH exemplify such a coalition. The American Public Health Association has earmarked 2017 the Year of Climate Change and Health. Workshops have been hosted monthly to illustrate how public health professionals can help build resilience for the traumas and toxic stresses of climate change.

Social Work needs to have a presence at such workshops and establish similar priorities. An example occurred when members of the International Federation of Social Workers organized a workshop at the UN Headquarters in New York. The Sustainable Development Goals (SDGs) are the Agenda 2030 of the United Nations. This workshop aimed to highlight social work’s role for reaching the Sustainable Development Goals on the local, subnational, national and international level.

Work with communities: This type of work is our profession’s biggest opportunity in the ecosocial work movement. Think Flint, Michigan where social workers were involved in going door to door, helping to mobilize groups to demand safe water. Social workers can identify food deserts and participate in, or organize food co-operatives, community supported agriculture and community gardens. The plight of migrant workers remains dire, particularly if undocumented. Studies have shown a significantly shorter lifespan among migrant workers due to pesticide exposure.

Family intervention, support groups, managing an environmental non-profit, providing education at the agency and community level are all ways in which social workers can use their skills. Rural communities affected by fracking or mountain-topping and the resultant loss of jobs, land, and health consequences beg for social work intervention. With the recent hurricanes and evacuation orders came reports of immigrants identified with DACA who resisted going to shelters for fear of being deported. Social work advocacy was needed to provide safety for such vulnerable populations.

Work with individuals: Most social workers provide service at this level. Borrowing from the afore-mentioned suggestions, micro interventions need to assess the environment in the person. How does the environment influence the presenting problem? Are there developmental residuals, is access to healthy nutrition an issue? What environmental barriers exist?  Is there a healthcare inequity?  Does the natural environment provide an opportunity for restorative or spiritual or transcendent experiences? Does it hinder or enhance our quality of life?

Identify the contextual environmental influences that your client may be experiencing. We are all aware of barriers to access, like lack of transportation that clients experience. But do we assess the pollution-laden community in which the client lives?

Of the three levels of social work intervention, micro, mezzo, and macro, several ways in which social workers can make an impact on environmental injustice have been identified.  It is imperative that social workers meet the grand challenge to create a social response to a changing environment. As global citizens, we have no choice.

For more information and resources please refer to my website:  https://sites.temple.edu/dewane/.

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Employment

Transformational Leadership in the Context of Social Work

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Social work leadership has transformed into actual practice from research. While the primary definition of transformational leadership remains the same, researchers and experts believe its practical implications show more promising and better results – especially in the context of social work.

Leaders who work in close collaboration with their subordinates to achieve a common goal is what transformational leadership is all about. However, when it comes to its implications, a real transformational leader possesses specific behaviors and traits beyond that definition. He or she is someone who does not only work with the team but also motivates and inspires an organization to work towards a shared vision.

For a leader to do that, he or she must have the inspirational motivation, intellectual stimulation, body language, and individual consideration for the society as a whole. When it comes to social work, the vision does not only limit to the group members but people beyond that.

For all these reasons, transformation leadership remains an imperative factor for the success at individual, organizational, and societal levels.

Traits of Transformation Leadership That Are Important in Context of Social Work

Social work in itself is a transformed organization. The way social campaigns are led has changed substantially with regards to how leaders should act. The effort and contribution of transformational leaders help in creating a work environment where the team members are committed to what they are assigned. Leaders support interactions to ensure providing stability to the employees and other team members working in favor of the organization.

Here are the top transformational leadership traits that give social work its best form.

Development and Growth on an Individual Level

The best leadership traits are those that help an individual with self-actualization. Referring to the hierarchy of needs by Abraham Maslow, self-actualization stands at the top of the pyramid because it enables an individual to see beyond their self-interest and work in favor of the people around.

This helps transformational leaders to work selflessly with the values and vision of the team as a whole, including the society. It’s the growth factor that facilitates him/her for this moral development and principles.

Improved Performance

Transformational leaders have subordinates and team members who perform beyond expectations. Research reveals that organizations, where transformational leaders are utilized, have better outcomes than planned.

The sense of trust and sustainability from the authority is a useful motivational factor that influences team members to outperform themselves every time. As a result, the overall performance of the organization and its contribution towards the shared vision also improves.

Organizational Change and Development

While transformational leadership has a clearly defined structure, it has an impact on every level of the organization. When it comes to team motivation, it helps the member become more inspiring, stimulating, and caring especially concerning their learning and working environment.

In short, it won’t be an exaggeration to state that transformational leadership has a ‘falling dominos effect’ on each department and the entire organization. While at authority level it helps with setting the vision and direction of the organization, at employee levels, it sets out the outlines for operations.

The phenomenon helps the company meet new challenges and perform better than expectations.

The Application is wider than Social Work

Society is and will always remain one of the most crucial areas where transformational leadership plays its role. However, the overall implication of the idea is much broader than that.

A variety of settings can benefit from the positive traits and behaviors of transformational leadership. Whether it is health care, nursing, education, or finance, the idea has proved more effective than any other form of leaderships. In addition to social work, it can also be applied to industrial and militaristic settings.

Conclusion

Since transformational leadership encourages the values of the people around, it plays a vital role in areas like social justice, equity, personal empowerment, self-knowledge, service, citizenship, and collaboration. This phenomenon can completely reshape the goals and how teams and organizations work and can also be used in conjunction with other leadership styles for better outcomes.

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