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