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The PAB-technique = social work- instrument in multiproblem cases Stockholm 2012 Herman de Mönnink, Netherlands www.mmsocialwork.

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Presentation on theme: "The PAB-technique = social work- instrument in multiproblem cases Stockholm 2012 Herman de Mönnink, Netherlands www.mmsocialwork."— Presentation transcript:

1 The PAB-technique = social work- instrument in multiproblem cases Stockholm 2012 Herman de Mönnink, Netherlands

2 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) ­

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

4 Question How can you as SW’er use the PAB-technique in multiproblem- client-situations?

5 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

6 1 Social Work-goals Stressreduction & empowerment on all levels

7 2 In life you must do it yourself but not alone -individual -systemic -macro Empowerment

8 Social work symbol? Stressors ---- Personal strenghts Social strengths

9 3 Bio-psycho-social stressors vs strengths Individual-interpersonal-macro cycles.

10 iSET: integrated Stressreduction & Empowerment Theory + Strenghts 5 Client- factors - Stressors 1. Life-events 2. Condition 3. Coping 4. Social interaction 5. Environment

11 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

12 SW-approach = always clientcentered Clientcentered = start, follow and end where the client is

13 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

14 SW approach in 3 steps 1. PAB (Personal Archive Box) 2. PSA (Psychosocial Stress Analysis) 3. PST (Psychosocial StressTreatment)

15 Step1 PAB: Personal Archive Box Again: Start-follow and end where the client is!!!!!!!!!!!!!!!!!!!!!!! Making contact and hearing clientstory Summarise and visualise in PAB

16 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.

17 - 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 Box Mrs. Multiplex

18 Step 2: PSA PsychoSocial Stress Analysis Individual & Social Strenghts? + Individual & Social Stressors -. strenghts stressors

19 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

20 3. PST: PsychoSocial StressTreatment working together for healthy balance Reduce individual & social stressors Empower Individual & social strenghts stressors

21 Scaling: stressmonitor 10x 9x 8x 7x 6 5xx 4x 3x 2xx = I feel totally relaxed Monitoring 10 = I experience maximum of stress

22 Scaling: empowerment monitor x 7xx 6x 5x 4xx 3x 2xx = I cannot manage myself Monitoring 10 = I can help myself

23 Progress Mrs. Multiplex by PAB clientcentered 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

24 PAB helps clients ordering, cleaning and clearing not only the real home but also the inner client-home Questions?

25 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

26 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 + + Helps focussing: what is actual & old unfinished business + Monitoring progress: effective SW-approach with this cl.?

27 Step 2: PSA Mrs. Multiplex (39) + Strenghts 5 Client- factors - Stressors 1. Life-events - Death of son - - Losing her home/electricity - - Income + Physicall healthy + Strong woman 2. Condition - - Depressed + Would like help of SW 3. Coping - Coping with depths - - Coping with grief and anger - - Refuses social service propositions + Support daughter (21) friend 4. Social interaction - I isolate myself from spouse, parents, others - Bad communication with spouse + Effective referrals general doctor to general social work 5. Services - Social program is very strict in conditions and rules - Psychopathologizing psychs

28 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.

29 PST Mrs. Multiplex Reduce inadequate problem-coping and existential coping Don’t know no what to do with my life…… 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

30 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 are influenced to a realistic direction Technique: challenging-technique

31 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

32 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)

33 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

34 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- method Goals: 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

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