The PAB-technique = social work-instrument in multiproblem cases

Stockholm2012

Herman de Mönnink, Netherlands

www.mmsocialwork

Herman de Mönnink­ 35 years Instructor School of Social Work­ Social Workers’ Toolbox (2004)­ Trauma-psychologist & grieftherapist in pp­ Founder Study of Loss in NL (book 2010) ­ Unfinished Business Syndroom (UBS)­ www.mmsocialwork.com

Overview presentation• Question• Assumptions theory SW-methods• Casestudy Mrs. Multiplex (39)• Definition PAB• Results PAB + other interventions• Conclusion

Question

How can you as SW’er use

the PAB-technique

in multiproblem-

client-situations?

Case Mrs. Multiplex (39)

• Referred by general doctor • Will be thrown out of her home • Social service blocked• No overview in income/administration/ • She does not react on calls• Serious debts• She is isolating from home and family• Was treated by psychologist - depression• 1 ½ years ago her son (19) died • Intelligent woman

1 Social Work-goals

Stressreduction

&

empowerment

on all levels

www.mmsocialwork.coml

2

In life

you must

do it yourself

but not alone

-individual

-systemic

-macro

Empowerment

Social work symbol?

Stressors ----

Personal strenghts

Social strengths

3 Bio-psycho-social stressors vs strengths

•Individual-interpersonal-macro cycles.

iSET: integrated Stressreduction & Empowerment Theory

+­Strenghts+­Strenghts 5­Client-5­Client-factorsfactors

-­Stressors-­Stressors

1.­Life-1.­Life-eventsevents

2.­Condition2.­Condition

3.­Coping3.­Coping

4.­Social­4.­Social­interactioninteraction

5.­5.­EnvironmenEnvironmen

tt

Multi-stressors = multi-method

Individual stressors > 9 individual methods problemstress, existential -, cognitive -,

emotional -, practical -, behavioral -, trauma-, grief-stressors

Interpersonal stressors >

7 systemic methods

Macrostressors > 4 macro-methods

SW-approach = always clientcentered

Clientcentered = start, follow and end where the client is

Mrs. Multiplex: multiproblem & complex, where to start and where to end?

Institutions/procedures?

Finance?

Health ?

Relation spouse?

Growing up children?

Social network?

Laws and services?

Traumatic incidents?

Debts?

Psychological problems?

Violence?

No Income

Psychosomatic complaints

Strong tensions/emotions of son-loss

Bad relation with spouse

No trust in others

Depressed

Cooperation with institutes

In debts-arrangement

Housing?

Insights?

Case management ?Threaths of losing her house

No insight of relation son-loss and multi-problems

Serious debts

In ‘war’ with institutes

SW approach in 3 steps

•1. PAB (Personal Archive Box)

•2. PSA (Psychosocial Stress Analysis)

•3. PST (Psychosocial StressTreatment)

Step1 PAB: Personal Archive Box

• Again: Start-follow and end where the client is!!!!!!!!!!!!!!!!!!!!!!!

• Making contact and hearing clientstory

• Summarise and visualise in PAB

Definition PAB

Visualizing

the clientstory

by drawing the client and

mark all stressors

with minus (-) and

all strenghts

with plusses (+)

in-words-of-the-client.

- My son (19) died 3 years ago- Help: I loose my house…

- Serious debts

--Refuses to accept rules of social service

-I close myself

- I do not speak with my spouse

- I do not share my grief

- I have grief and anger-attacks

+ I feel a strong woman

+ I am physically healthy

+ Would like to have help from SW

- Miss my son

-- Psych did not help effectively

+ Supported by my friend

+ Supported by general doctor

Step 1. PAB = Personal Archive BoxStep 1. PAB = Personal Archive Box Mrs.

Multiplex

Step 2: PSA PsychoSocial Stress Analysis

Individual & Social Strenghts?+

Individual & Social

Stressors -.

strenghts

stressors

PSA Mrs. Multiplex : unhealthy balance? strenghts (+) vs stressors (-)

•Individual strenghts+ phyically health+ Intelligent woman + Looks for SW-help

Individual & social Stressors

-Son died-Depths

-No income-Threath of eviction

-No energy-Depressed

- Grief and anger -Discommunication with spouse, -No family-support and network

-Strict rules and conditions social service dpt.

strenghts

stressors

Social strengths+ Support by daughter + friend + Effective refer-system from general doctors to social work

3. PST: PsychoSocial StressTreatmentworking together for healthy balance

Reduce

individual &

social

stressors

Empower

Individual &

social

strenghtsstrenghts

stressors

Scaling: stressmonitor

10 x

9 x

8 x

7 x

6

5 x x

4 x

3 x

2 x x

1

0 1 2 3 4 5 6 7 8 9 101 = I feel totally relaxed

Monitoring

10 = I experience maximum of stress

Scaling: empowerment monitor

10

9

8 x

7 x x

6 x

5 x

4 x x

3 x

2 x x

1

0 1 2 3 4 5 6 7 8 9 101 = I cannot manage myself

Monitoring

10 = I can help myself

Progress Mrs. Multiplex by PABclientcentered multimethod social work

Mediation?

Finance?

Health care?

Relation spouses?

Grown up children?

Social network?

Laws and services?

Traumatic incidents?

Debts?

Psychological problems?

Violence?

Income is ok

Reduction psychosomatic complaints

Releases tensions/emotions of son-loss

Attachment with spouse improved

Getting more trust

Not depressed anymore

Cooperation with institutes

In debts-arrangement

Housing?

Insights?

Case management ?No threath of losing her house

More insight of relation son-loss and multi-problems

Is in debts-arrangement

More in cooperation with institutes

PAB helps clients ordering, cleaning and

clearing not only the real home but also the inner

client-home

•Questions?

Contra-indications PAB

Urgent crisis (client urgently needs crisisintervention) Client is physically and emotionally too weak Insufficient cognitive functioning Simple question/problem: no need for collection by PAB

PAB-technique: advantages?

+ Collecting & improving consciousness+ Prioritize: stressors & strengths overview, no tunnelvision+ Clarity about tasks to be done by the client and by the

social worker+ Client gets/holds direction in social work-contact + cl.life+ Helps focussing: what is actual & old unfinished business+ Monitoring progress: effective SW-approach with this cl.?

Step 2: PSA Mrs. Multiplex (39)

+­Strenghts+­Strenghts 5­Client-5­Client-factorsfactors

-­Stressors-­Stressors

1.­Life-1.­Life-eventsevents

-­Death­of­son­--­Losing­her­home/electricity--­Income­

+­Physicall­healthy+­Physicall­healthy

+­Strong­woman+­Strong­woman2.­Condition2.­Condition --­Depressed

+­Would­like­help­of­SW 3.­Coping3.­Coping -­Coping­with­depths­--­Coping­with­grief­and­anger--­Refuses­social­service­propositions­

+­Support­daughter­(21)­friend­

4.­Social­4.­Social­interactioninteraction

-­I­isolate­myself­from­spouse,­parents,­others­-­Bad­communication­with­spouse­

+­Effective­referrals­general­doctor­to­general­social­work

5.­Services­5.­Services­ -Social­program­is­very­strict­in­conditions­and­rules-­Psychopathologizing­psychs

Psychosocial Stress Treatment (PST) Mrs. Multiplex

•Reduce inadequate coping with institutes

•Mrs. Multiplex is not obeying the rules•Mrs M. reacts with anger on officials who threaten her with homelessness, cutting her off electricity

•Practical materialistic method•Goal: reduce stressors by helping

practically with housing and materialistic problems .

•Techniques: Informing, referrals, advocay, mediate,concrete help.

PST Mrs. Multiplex

• Reduce inadequate problem-coping and existential coping

• Don’t know no what to do with my life……..so start a war against

Non-directive counseling-SW-method• Goal: making time for dealing with

the loss of her son and making up

balance in questions like ‘why did this

happen to me’? • Technique: counseling to establish a working

relation

PST Mrs. Multiplex

•Reduce unrealistic cognitive coping• I will not share my grief, because they will not listen

•Cognitive SW-method•Goal: unrealistic, negative, harmful thoughts of

Mrs. M. about herself and the world areinfluenced to a realistic direction

•Technique: challenging-technique

PST Mrs. Multiplex

• Reduce inadequate behavorial coping• I am pissed off when one is frustrating me

• Behavior SW-method• Goal: learn assertive skills (not aggresive)

• Technique: social-skill-training

PST Mrs. Multiplex

•Reduce inadequate social interaction

•Mrs. M. is very unhappy and angry and destructive after losing her son. •Refuses support and contact with family and network•Refuses to share her grief with spouse and others

•Couple- and network-SW-method•Goal: attach to spous and others in sharing grief

and solving communication problems •Technique: communication and LSE (Listen Summarize Empathy)

PST Mrs. Multiplex

• Reduce inadequate Services• Rules are too strictly for crisisclients• Psychopathologing depressed clients

• Macro-SW-methods• Goal: structural improvement of cooperation

between social services and clients; normalizing clients wityh grief

• Techniek: class advocasy and articles

PST Mrs. Multiplex

•Reducing emotional stress losing her son

•Mrs. M. is building up inside: grief, anger after losing her child

•Non- directive counseling, discharge-method & ritual-methodGoals: hearing the clientstory and ackknowledge the

tragedy and help her to discharge her feelings, and finish the emotional unfinished business

•Techniques: safetytechnique, miror-technique, say-goodbye-technique