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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

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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

Education

Non-traditional Students Require Non-traditional Policies for Field Placements

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I am only six weeks away from completing my BSW degree; a degree that has taken nearly twenty years to complete.  As I am nearing the end of my current educational journey and in the final hours of my field placement, I have found myself becoming quite reflective about my educational experience.

Now, I am not your traditional BSW student, and as such, my experience is dramatically different from many individuals who enter a BSW straight out of high school.  I have never sat in a physical class or classroom; I have never met any of my classmates and my professors or instructors face-to-face.  I am thirty-six years old with two children, and I work full-time in a field where I have spent the last sixteen years in.  No, I am not your traditional BSW student; I am a new breed of student, an older nontraditional online student.

Advances in technology have flung wide the doors of innovation in higher education. Online programs, developed in the last ten years and refined in the last five, have drastically changed the face of higher education for non-traditional students like me, who would have had no other opportunity to complete a degree.

Due to their ability to offer flexibility to students, online programs have become a permeant feature on the higher education landscape, and their popularity and student population are growing at an exponential rate. The academic training of future social workers has not been exempted from the advancements in technology and education. My soon-to-be alma mater and one of the leading online social work programs in the nation have reported a 34% increase in the number of students enrolled in the online BSW program this year alone.

While there have been major leaps forward in distance learning and online education, there has been little to no innovation regarding CSWE accreditation policies concerning this new breed of students, especially as it pertains to their field placement.

As it stands, all CSWE accredited schools, including non-traditional online programs function under the same blanket policy regarding field placement. Students enrolled in BSW programs are required to perform a minimum of four hundred unpaid hours of field placement at a social service agency. The policy also requires that field placement hours be served in conjunction with educational direction.

The CSWE considers field placement the “signature pedagogy” of social work education as it offers future practitioners the opportunity to apply theories learned in the classroom by exposing them to all sorts of problems and situations.  There is no debate concerning the importance of the field placement experience.  Incongruence occurs, however, due to a lack of nuance in policy when it comes to the unique needs and strengths of non-traditional learners.

Many non-traditional students, like me, who find an educational home in online BSW programs, are typically older adults either seeking to complete a bachelors degree they forsook earlier in life, seeking to further their current career, or shift their career entirely into a new filed.  While the reasons non-traditional students have for returning to school through an online program vary, one thing is common for us all.  Each student brings many years of life experience and employment history to the program.

Personally, when I started my online BSW program, I had over sixteen years of social services experience; working for years in a therapeutic boarding school for teenagers on the verge of incarceration, pastoral ministry, and serving as the Executive Director of a large non-profit social services organization.  I am not alone in bringing this level of experience in my current distance learning program.

In an informal survey conducted by current and former students of my school’s online BSW program, sixty percent of students reported that their resumes reflect positions comparable to that of social workers with fifty percent of responders stating they were employed by a social services agency while also performing their field placements. Students reported they have or are serving in capacities such as SUD Therapist, Program Coordinator, Outreach Specialist, Case Manager, Addiction Recovery Specialist, Youth Career Specialist, and Parent Mentor.

It is safe to assume that students from other online programs would report the same data. As such, it is important for the current CSWE and school policies concerning field placement for online programs be reviewed and discussed to create the most effective learning environment for these unique students. If the current policies are followed, older non-traditional students will not have the desired experience as CSWE and accredited schools for BSW students.

If there is no change in how these students are viewed and the policies surrounding their placement, the CSWE and institutions of higher learning run the risk of non-traditional students viewing their service hours as a mere assignment that must be completed to graduate.

To be honest, this has been my thinking on more than one occasion during my field placement. While I have learned a substantial amount about the agency I have worked in and it has been truly informative, I have also found myself questioning whether this experience was truly fulfilling the mission and vision the CSWE and my school had in mind when policy was crafted concerning BSW field placement making it the signature pedagogy.

Often times in my placement, I found that due to my life and employment experience, I was more qualified to perform the duties and tasks than those I was shadowing and being supervised by. I do not relay this out of a sense of arrogance, but sheer professional experience.

Due to the nature and requirements of my field placement setting, I have spent a majority of my time shadowing new social workers or others who do not have a BSW at all. There is much to be gleaned by working with these individuals in an agency setting and hearing about their roles and responsibilities.

There is also great value in navigating through interpersonal issues that arise in a field placement setting. This aspect of placement has been invaluable to me.  What has become cumbersome, however, is trying to relate to my agency, my placement, and my future practice of social work as if my life experience and employment history were non-existent and as if the position I may potentially secure after placement will be my first professional job.

The current framework concerning BSW field placement is to provide students with experience in generalist practice with the hope that after field placement and graduation, students will secure jobs in social services agencies as entry-level generalist social work practitioners. This is a fine and noble objective to have, but the reality is a majority of older non-traditional students will not seek entry-level positions.

As their resumes reflect extensive knowledge and experience, the addition of a BSW degree will only elevate them to higher levels of employment.  To use a professional metaphor, these older non-traditional students will most likely not be starting at the “bottom of the ladder.” With that being the case, it would be prudent and wise for these students to be placed in advanced practice settings with more intensive supervision, settings that will mirror the level they will be entering the profession of social work in.

While this may not be true for everyone enrolled in online programs, it is true for many; and those individuals deserve to have a field placement setting and experience that will rightly prepare them for the work they have before them in the professional field.

I am by no means suggesting for a cessation of field placement for older non-traditional students. Field placement is imperative and a means by which students safely test theories and gain invaluable experience.  I desire to open a dialogue concerning the needs and strengths of the non-traditional students and how to best serve them during this crucial time of learning.

However, a new examination of the CSWE requirements, policies, and procedures of institutions of higher education with a manner of nuance should be given to this growing student population. It will ensure these older non-traditional students who are finishing their degree and entering the practice of social work receive a placement that meets their educational and professional needs rather than being an exercise in futility to complete a requirement.

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News

Opening Paths for Europe’s Children: Best Practices and Transitions from Introversion to Extroversion

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Photo Credit: LamiaReport.gr

The Social Welfare Center in the Central of Greece Region at the Ministry of Labor, Social Insurance & Social Solidarity is one of the leading regional social structures taking the initiative to re-open conversation on the investment and need of alternative children protection based on the promotion of foster care, adoption, and deinstitutionalization in child welfare.

On November 20, 2017, a coalition of specialized and distinguished professionals from the European Region, such as Jane Snaith, CEO Family for Each Child (Igale Lapsele Pere) from Estonia, Marina Hoblaj and Alisa Fistrek, Forum for Quality Raising of foster children (Forum za kvalitetno udomiteljstvo djece – udomitelji za djecu) from Croatia, Mary Theodoropoulou and Tatiana Gorney, “Roots” Research Center (NGO) from Greece, “Eurochild” participated in the “Opening doors for Europe’s children” campaign. This brain trust of professionals and specialists shared their lived experience and knowledge in this crucial field in order to engage and stimulate public concern for alternative child protection.

Additionally, they discussed some of the best practices being used abroad to encourage other professionals, social workers, social care workers, etc. to adopt them and incorporate into their practice in order to start shaping a different approach, mentality and organizational culture for those making and implementing policies on the day to day life of children. On the grounds of the current and abundantly quite rigid national legal framework, reformation is needed to define the comprehensive disadvantages of the foster care and adoption process in addition to addressing the shortage of multidimensional help that has plagued the profession for all these years.

In the context of exchanging views on the necessity of a more extroverted social perception establishment in the Greek territory, a special workshop was held for all those interested in better vocational training. Professionals working with children need support in their professional lives in order to fulfill their day to day work to secure, defend, and emphasize on fundamental children and youth rights.

Not only had they already implemented to intensify already fruitful and constructive endeavors towards deinstitutionalization and family care under the current circumstances, they still keep to facilitate and invite public concern to establish rapport on a crucial issue in question akin to a modern and fair pretention.

Social Welfare Center of Central Greece Region is a public legal entity akin to the managerial mechanism of three social structures which encompasses the Department of Child Protection of Fthiotida, Department of People with Disabilities of Fthiotida, Department of People with Disabilities of Evoia. This social welfare entity is the state’s main bracket in the above-mentioned territory.

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Child Welfare

How to Support Foster Children

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When you choose to become a foster carer the rewards can be great. Supporting a child through a difficult period in their life, watching them grow and develop into a well-rounded individual; it’s understandable why so many choose to pursue this worthwhile vocation.

However, as with any profession, it does come with some downsides. Primarily helping some children to cope with the trauma and stress that being in foster care can evoke.

So, how can you best support a foster child in a meaningful way? One that will be beneficial to the both of you.

Listen

Feeling like the most overlooked member of society can have a damaging and long-lasting effect on foster children. Meaning that the simple act of offering them an ear to vent their worries, experiences or anything at all can be extremely positive. It establishes you as a point of reason in their life.

You can’t always solve the issues that are brought up during these moments. Nor should you try, but it is worthwhile simply being there to hear. Because, at the end of the day, your foster children deserve to be listened to.

Celebrate

Birthdays. Christmas. Halloween. Important events can often go overlooked as a foster child. So, taking the chance as a foster parent to celebrate these milestones – no matter how little or big – can be the change that a child needs. Simple things such as helping put up a Christmas tree could be a moment they will remember for a long time to come.

And at the end of the day events like Halloween and Birthdays are fun – something every child needs a little more of in their lives.

Playdates

Your support is vital, but often the support of peers can also be invaluable for the wellbeing of those children in foster care. Setting up playdates – even for older children – can be a great way to help them interact and enjoy time with children their own age.

Older children or teens may be unreceptive to you making playdates for them. But, arranging ‘coincidences’ of kids their age coming over can always be an alternative solution. What they don’t know…

This can also be beneficial for any of your own children that may also be in the house. A disgruntled foster child can be a distressing presence in the home, so balancing this out with a familiar friend and playmate is often needed to offset this. All of the children in your home can benefit from socialising with others both in and outside your own home at times,

Getaway

Sometimes life can get a little too much when you are forced to come and go through a number of foster homes, which is a reality for many foster children. A day out – not even an expensive day out or holiday – can be a bright spot in an otherwise overcast moment in their lives. The zoo, beach, museum and even the park can be an adventure.

It’s not always clear what a child is going through, nor will they always express their emotions in healthy ways. Removing them from the environment which creates these feelings can be a relief in many cases.

Help with School

On average, foster children tend to do worse academically and behaviour wise in school than other children. The reasons are often self-explanatory, but it is something which you can positively influence whilst they are under your care.

Helping with homework, actively engaging with teachers over what you can do further to help and encouraging after-school activities are some ways to do this. Goals should be set, but ensure they are realistic and rewarded when surpassed.

Overall, being a foster parent is a big task but one that can bring so much enrichment to a child’s life. As a solid figure in their life, you can help ensure the rest of their life is more positive than the start. Supporting a foster child can be a challenge, but that makes it all the more rewarding when you see a positive effect on the life of a child.

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