Gestalt Therapy Notes

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Developed by Fritz Perls and Laura Perls

grounded in existentialism…literally means form….basically, the parts make up the whole, but the whole has far more meaning than the parts

Gestalt therapy: provide context and perspective that increases awareness for what we are experiencing

  • Grounded in the here-and-now…focus on awareness, choice and responsibility
  • Awareness allows us to  find the resources within us to solve our problems and discover conditions that make change possible
  • Basic assumption: we CAN self-regulate if we are aware of what is happening around us

Paradoxical theory of  change – change will happen as we become aware of what we are ….as opposed to trying to be who we really are not…in other words, accept who and what we are instead of trying to be what we should be

Gestalt Principles

Holism – our whole is greater than the sum of our parts

Field theory – everything is connected – what exactly is happening at the boundary between us and our environment

Awareness – instead of why…focus on what and how

Here and now – the past is past and the future is not here…The past is important only in how it relates to our current being and functioning. Gestalt therapy tries to bring past problems and situations into the present.

Unfinished business – unexpressed rage, hurt, anxiety, guilt, shame, grief, and hate will continue to haunt us unless we deal with it

Contact – Effective contact is when we interact wholly in our environment and with other people without losing our own individualism

Disturbances to Contact:

Introjection – just  go along with others without considering how they fit with our beliefs and standards

Projection – we disown parts of us that we don’t like and project those traits onto others

Retroflection – lashing out on ourselves in ways that we really want to lash out  to others

Confluence – when we don’t  distinguish  ourselves from others or the environment…we NEED to fit in and be accepted….we are the group/environment

Deflection – humor and questions…more humor and questions…can’t get to know the person because  they deflect from who they really are


Change “it” talk to I talk……change “you” talk to I talk….instead of asking questions, make statements…

Change can’t statements to won’t statements

Be aware of “shoulds and oughts”

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Existensialism Notes

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From Gerald Corey’s Theory and Practice of Group Counseling: The existential tradition seeks a balance between recognizing the limits and tragic dimensions of human existence on one hand and the possibilities and opportunities for  humans to transcend those limits to achieve a vital existence on the other hand.


Key components of the theory:

  • challenge individuals to take responsibility for their life’s direction
  • help individuals remain the present
  • help individuals increase awareness as to how they block themselves from a more fulfilling existence
  • encourage individuals to “expand their horizons” with respect to their daily existence
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Freud – Psychoanalytic Notes

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Freud said the purpose of therapy was “to be able to love and to work”.

Freud focused on the understanding of psycho-sexual development. Erick Erickson took it further with his focus on psychosocial development…Freud was not a happy camper about that.

The focus is on the historical antecedents of current behavior….our history is what subconsciously guides us.

Ego Defense Mechanisms

  • Repression – push the bad stuff into our unconscious
  • Denial – suppress bad stuff…but we are still fully or semi-conscious of  it
  • Regression – revert back to an old pattern or coping mechanism that used to work
  • Projection – accuse someone else of  being how  we guiltily feel we actually are
  • Displacement – Misplaced anger, take out your anger on a safer target…Mad at your spouse? Go kick the dog.
  • Reaction Formation – A  man fearfully still  in the closet and ashamed may vehemently lash out at openly gay people.
  • Rationalization – We can justify about anything if it suits our needs.

Psychoanalytic Approach to Groups

Psychoanalytic Approach

  • Major influence in other models
  • Freudian approach
  • Alexander Wolf first credited with using psychoanalytic principles for groups (1938)

How does the psychoanalytic approach work?

  • By restructuring the client’s character and personality


  • By making unconscious conflicts conscious and examining them

How do you do that?

  • Repeating the historical past in the present by reenacting the family of origin in a symbolic way

Use of the Past in Psychoanalytic Approach

  • first six years of life
    • inability to freely give and accept love; difficulty recognizing and dealing with emotions; resentment and aggression; independence and dependence conflicts; difficulty in separating from one’s parents; avoidance of intimacy; difficulty accepting one’s sexual identity; and guilt over sexual problems
  • modern analytical approaches include the incorporation of past, present, and future events

The Unconscious

  • The thoughts, feelings, motives, impulses, events that out kept out of our awareness to protect against anxiety
  • Freudian concept
  • Human behavior is motivated by the unconscious
  • The events in the unconscious never go away with time, so the client will still feel dealing with the anxiety provoking situation as intolerable
  • Choices are not freely made but influenced by the unconscious
  • Goal of psychoanalytic therapy is to bring unconscious to the conscious mind, as one can become aware of what are the motivations behind their behavior
  • Done through dreams, free-association, transference, and interpretations
  • Anxiety is the result of unconscious material breaking through.

Ego-Defence Mechanisms

  • Way to explain behavior
  • Protects the ego from threatening thoughts and feelings
  • Learned behavior
  • Often start in childhood and continues throughout adulthood
  • Repression, Denial, Regression, Projection, Displacement, Reaction, and Rationalization


  • pushing distressing thoughts/ feelings into the unconscious
  • blocking memories
  • some have no recollections of traumatic events


  • Coping with anxiety by pretending the source does not exist
  • Can be the refusal to accept that there is a problem
  • Deception is a common trait in denial, to one’s self and to others


  • Returning to a less mature developmental level
  • Reverting to old patterns of behavior that may have worked at a previous point in time


  • Attributing one’s own unacceptable thoughts, feelings, behaviors and motives to others
  • Pointing out flaws in others that you see in yourself


  • Redirection of an emotions from the real source to a substitute object or person
  • Common for one to choose a non-threatening target to direct their anger

Reaction Formation

  • Behaving in a way that is opposite to what one is really feeling
  • A common way to avoid anxiety provoking feelings
  • Examples
    • “This won’t hurt that bad”
    • “It doesn’t really bother me if I’m rejected”


  • Justification of behavior through logic
  • Coming up with reasons to justify negative feelings or emotions


  • Apprehension to bring threatening material into the conscious mind
  • OR anything that gets in the way of dealing with unconscious material
  • Defence against feeling emotion pain/anxiety
  • Can materialize in the form of
    • apprehension about joining a group
    • participation in the group
    • desire to leave the group
  • Other ways resistance can manifest
    • Arriving late
    • Attitude of Indifference
    • Intellectualizing
    • Trying to help other group members in an exaggerated way
    • Distrust
    • Uncooperative
    • Inappropriate behavior
    • Using the group for socialization
  • To work through this the therapist must start with the client’s immediate problems, working through them together and recognizing them as blocks against anxiety
  • Criticism will only increase behavior


Unconsciously shifting feelings about significant people in the past to people in the present

  • Therapy setting should be a comfortable place to express these feelings
  • Tend to compete for attention from the leader (therapist) just as a child one would compete for the attention of their parents
  • Group setting allows for multiple transferences to the therapist as well as other members of the group


The therapist’s unconscious feelings toward the client, resulting in distorted perceptions of the client’s behavior.

Common Examples:

  • Taking advantage of having the position of power, using seductive behavior to get the attention of the group members
  • Seeing traits that you dislike in yourself in members of the group, thinking that member may be difficult to work with
  • Overidentifying with the clients

Countertransference Continued

  • Recommended that therapist undergoes their own analytical therapy session to become conscious of how they may obstruct therapeutic tasks
  • Countertransference common for group therapists
    • Five most common countertransference patterns of a therapist
      • emotionally withdrawn and unavailable
      • passive
      • overly controlling
      • regression
      • paternalistic

Role of the Group Leader

  • Reacts rather than initiate
  • Waits for the group process to occur and then comments on it
  • Emphasizes the therapeutic alliance between the therapist and the client
  • Gives support when the group is not providing it
  • Aids with resistances from the clients
  • Aids in the process of awareness of the clients behavior

Client Benefits of Psychoanalytical Therapy

  • Build relationships in a safe environment
  • Learn how their defenses and resistances are manifested
  • More dependence on other group members instead of just the therapist
  • Learn to express intense feelings
  • Centrally focuses on controlling and limiting anxiety, allows the client to realize that anxiety and its defences are normal

Psychoanalytic Therapeutic Techniques

  • Free Association
  • Interpretation
  • Dream Analysis
  • Insight and Working Through

Free Association

  • Communicating whatever comes to mind regardless of what it is
  • Reporting feelings fully and without censorship
  • Talking about whatever is brought up instead of a specific theme
  • In group setting members are encouraged to make comments and free associate with each other member


Used in the analysis of free association, dreams, transference, and resistances.

Attaching meaning to behaviors.

  • A skill that if used well can allow client to gain valuable insights
  • Interpretations are not truth but a hypothesis
  • Interpretations asked as questions are more likely to be considered by the client
  • Interpretations should start out superficial and go emotionally deeper
  • Interpretations can be met with defense mechanisms and the therapist should point this out

Dream Analysis

  • Dreams have both a conscious meaning and a hidden meaning
  • Group members are encouraged to offer their own interpretations
  • Essential aspect of the analytical process
  • Dreams can reveal how the group member views the therapist and other members

Insight and Working Through

Insight is awareness into the cause of your own difficulties.

Working through is the resolution of dysfunctional patterns.

  • Very complex part of psychoanalysis, requires deep commitment
  • Can be a painful experience for the client that requires reexperiencing traumatic events
  • Never completely frees the individual from old patterns, but is an acceptance process

Developmental Stages

This model pulls both from Erikson’s 8 stages of psychosocial development and Freud’s psychosexual stages of development.

Reflecting on each person’s experiences during these stages can reveal a lot about their behaviors and emotions about current life events.

Stage 1: Infancy- Trust vs. Mistrust

  • Freud’s “oral stage,” in this stage of life infants are dependant on parents to feel safe and protected. Without proper care the child will grow up to be fearful of intimacy and have difficult relationships.
  • Group leaders can work with members to express their pain and to help break down barriers that are preventing them from trusting other people.

Stage 2: Early Childhood- Autonomy vs Shame and Doubt

“anal stage” a child must learn how to cope with negative feelings like anger and must start learning independence and accepting personal power. Parent’s role of praising/punishing and having expectations of independence is important.

Group members may need to “relive” or “re-experience” situations from the past that they have intense conflicting feelings about and work through the guilt associated with them.

Stage 3: Preschool age- Initiative vs Guilt

“phallic stage” and the Oedipus Syndrome. Erikson stresses the children’s ability to make own decisions and follow through with them vs not making decisions or being criticized for decisions.

Group members may be concerned with sexual feelings, behaviors, values, or attitudes that they have. They may be concerned about their gender role and the group is a safe place to discuss concerns.

Stage 4: The School Age- Industry vs. Inferiority

“latency stage” sexual desires have tapered off.

Industry refers to setting and attaining meaningful goals. If a child fails to do this they may feel inadequate.

Group members may have to go back to relive and reexperience the pain of inadequate feelings in childhood to move on and face their fears of failure as adults.

Stage 5: Adolescents- Identity vs Identity confusion

Adolescents must struggle with breaking ties of dependence and reacting under pressures stemming from multiple social sources. If they fail to do this they may have identity confusion

Groups generally spend a good deal of time exploring and resolving problems with dependence/independence conflict and struggles of individuality and autonomy.

Stage 6: Early Adulthood- Intimacy vs. Isolation

In this period establishing intimate committed relationships and establishing a satisfying lifestyle is important. Isolation can occur if intimate relationships do not form.

Groups often dedicate a lot of time to discussing issues with intimacy. Often people struggle with maintaining independence while caring deeply for other people.

Stage 7: Middle Adulthood- Generativity vs. Stagnation

Focus on reexamining how one is living and trying to guide the new generation. Can be painful to reflect on what was intended to be accomplished in early adulthood and what was accomplished.

Group work can be used to change people’s negative views about their accomplishments and help them find new value and meaning in life.

Stage 8: Later Life- Integrity vs. Despair

adjusting to the deaths of loved ones, maintaining interests, adjusting to retirement, and reviewing the past. Looking back on the past with integrity or despair.

Groups are therapeutic for older persons because it can help diminish feelings of loneliness and can direct members to focus on the positive aspects of their age.

Object Relations Theory

  • Interpersonal relationships that shape a person’s current interaction with people
  • Object relations therapy is based on the premise that early in life the individual has drives that are satisfied through attachment to specific people, primarily parents.
  • These early interactions lay the foundation for relationship patterns later in life

Attachment Theory

Infants emotionally bond with a caretaker who provides a sense of security.

The better an infant’s needs are taken care of, the stronger the relationships they will have later in life.

Borderline Personality Disorder

A borderline personality disorder is characterized by bouts of irritability, self-destructive acts, impulsive anger, and extreme mood shifts.

people with BPD are not easy to work with in groups, but they are even harder to work with individually. They can often use the support from the group and test the boundaries of what is reality against what their thought process is.

Narcissistic Personality Disorder

This syndrome is characterized by an exaggerated sense of self-importance and an exploitive attitude toward others, which serves the function of masking a frail self-concept.

Like people with BPD, it is difficult to make progress with narcissists in groups. Particularly when they elicit strong negative emotions from therapists, which they often do.

Future of Psychodynamic Approach

  • Integrative therapy with Cognitive behavior therapy.
  • Treating selective disorders in 10-25 sessions

(focuses on strengths and here-and-now)

  • Psychoanalytical approaches are helpful in school settings where children are in adolescent stage.


  • Too much emphasis on child-mother bond and blame on mother.
  • Addresses ways to reconstruct long term personality problems and does not focus on short-term problem solving.
  • Usually a lengthy and expensive process.
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Multisystemic Therapy

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Interventions for First-Time Juvenile Offenders in Central and Northwestern Oklahoma

Erin Andrews and Steve Weber

University of Oklahoma



Juvenile delinquency in Oklahoma is a problem that negatively affects the offenders, their victims, and society as a whole. Besides the emotional and family aspects, the monetary costs for dealing with juvenile delinquency are staggering. The use of effective EBP therapeutic interventions could reduce the number of repeat juvenile offenders in Oklahoma. Although much attention is placed upon providing interventions to first-time juvenile offenders, there are questions as to whether Oklahoma is using the best available interventions. Multisystemic Therapy (MST) is an evidence-based program (EBP) utilizing multiple therapeutic methods collectively addressing change at all three sociological levels (i.e. micro, mezzo, and macro) to reduce delinquent behavior in juveniles. Analysis of the agencies in central and northern Oklahoma providing services to first-time juvenile offenders resulted in a discovery that none of the agencies are delivering an EBP backed by empirical evidence of there effectiveness with juvenile offenders. Lastly, a comparison of the commonly used services in Oklahoma to MST results in a recommendation for the utilization of MST in Oklahoma.

Key Words: Juvenile delinquency, first-time juvenile offenders, Evidence-based program (EBP), Multisystemic Therapy (MST)







According to the Oklahoma Office of Juvenile Affairs’ (OJA) website (OJA, 2012.), the annual expenditures for fiscal year 2012 were $105,770,346. During that same time period, the Office of Juvenile Affairs reported contact with 11,494 Oklahoma youth. Of those youth, 3,707 had their cases dismissed or otherwise referred out of the juvenile system without having services provided. That leaves 7,787 youth who remained in the system receiving services in some manner. This equates to an annual expenditure by the Office of Juvenile Affairs of $13,582 per youth for the 2012 fiscal year. It seems fair to question whether or not those funds are, in fact, being used in the most appropriate manner to address the problem of juvenile delinquency in Oklahoma.

The question of whether or not funds are being used effectively becomes even more important when one considers that of the 7,787 youth in the system, 4,394 are repeat offenders. Unfortunately, statistics may indicate that Oklahoma is not performing well in addressing the problem of juvenile delinquency. According to the Justice Policy Institute (2009), with respect to success rates among U.S. states for reducing juvenile crime rates, Oklahoma ranks in the bottom ten states. In other words, forty states do a better job of reducing their rates of juvenile crime than does Oklahoma. Considering that in 2012, 56% of the youth placed into the Oklahoma juvenile system were repeat offenders, reducing the recidivism rate would strongly and positively impact the overall problem of juvenile delinquency in Oklahoma. Is Oklahoma using the most effective evidence based interventions to address the issue of juvenile recidivism?

Literature Review of MST

            Multisystemic Therapy (MST) is a therapeutic intervention often used with juvenile offenders to address delinquent behavior and reduce ones rate of recidivism. Several empirical research studies have provided evidence for the effectiveness of MST in regards to the reduction of delinquency, also known as antisocial behavior, in children and adolescents (Borduin, Mann, Cone, Henggeler, Fucci, Blaske, and Williams, 1995; Curtis, Ronan, & Borduin, 2004; Ogden & Halliday-Boykins, 2004; Schaeffer & Borduin, 2005; Sawyer & Borduin, 2011). Through this empirical support MST has been deemed an evidence-based practice (EBP). In other words, it is “best-practice” or strongly recommended when addressing juvenile delinquency therapist, agencies, and state juvenile justice departments utilize MST. Henggeler, Schoenwald, and Pickrel (1995) states:

MST is consistent with social-ecological models of behavior (e.g., Bronfenbrenner, 1979) in which the child and family’s school, work, peer, community, and cultural institutions are viewed as interconnected systems with dynamic and reciprocal influences on the behavior of family members. (710)

Additionally, MST was developed based upon empirical research that discerned a strong correlation between youth criminal and violent behaviors with poor interpersonal family relations, deviant peer association and school performance (Schaeffer & Borduin, 2005). Subsequently, these are the areas targeted for change in this multi-leveled approach to intervention.

Upholding the person-in-environment ethos of the social-ecological model the creators of MST require the intervention take place in the environment one is experiencing the most difficulty. Therefore, services could take place in the individuals’ home, school or neighborhood. Initially, the assigned therapist conducts an assessment of the individual and family to determine the service site and ensure the specific needs of the client and family as a whole are the foci of the intervention (Sawyer & Borduin, 2011). Allowing for flexibility in the intervention model and using a person-centered approach has been seen as one of the reasons why MST is consistently effective (Ogden & Halliday-Boykins, 2004). Moreover, this approach is congruent with the social work ethical standard of the client’s right to self-determination (NASW, 2008). The inclusion of family therapy in MST aims to establish a working parent – child relationship and provide the parent/caregiver(s) with the skills and resources necessary to mange the youth’s problem behaviors. At the macro level, MST can create two changes that benefit society as a whole. First, the reduction of criminal and violent activity is beneficial to all. Second, Klietz, Borduin, and Schaeffer (2010) found:

The reductions in criminality in the MST versus IT conditions were associated with substantial reductions in expenses to taxpayers and intangible losses to crime victims, with cumulative benefits ranging from $75,110 to $199,374 per MST participant. Stated differently, it was estimated that every dollar spent on MST provides $9.51 to $23.59 in savings to taxpayers and crime victims in the years ahead. (657)

Overall, MST strives to create change at all the sociological levels micro, mezzo and macro.

Borduin et al. (1995) conducted the first clinical trial looking at the long-term effectiveness of MST in relation to the reduction of criminal and violent activity in MST participants compared to IT (i.e. individual therapy) participants. The initial study was conducted four years after services were provided; subsequently, there have been two more follow up studies with the same participants around 13.7 and 21.9 years after services were initially provided (Schaeffer & Borduin, 2005; Sawyer & Borduin, 2011). Bourduin et al. (1995) found that within the four gap only 21.6% of the MST participants had been arrested compared to 71.4% of the IT participants. Schaeffer & Borduin (2005) found as adults the arrest percentage had increased to 50 %; however, these participants were also sentenced to fewer days in jail and awarded shorter probation. Lastly, Sawyer and Borduin (2011) were the first ones to look at suits related to family instability and found MST participants were half as likely to be involved in a divorce, paternity, or child support suit compared to the IT participant. Collectively, all three studies provide the evidence for the lasting affects of MST on criminal and violent behaviors in addition to quality of life for children and adolescent offenders years after service.

In a meta-analysis of numerous outcome-based (i.e. effectiveness) studies Curtis, Ronan, and Borduin (2004) found collectively the MST participants were 70% less likely to reoffend in the years following treatment compared to participants receiving common services. Moreover, Ogden and Halliday-Boykins (2004) found MST to be effective for adolescents with serious behavior problems in Norway. Thus, providing empirical evidence to the reliability of MST across cultures. Research has shown fidelity to the MST program is vital to its effectiveness and to counter act infidelity the MST adherence measure was created in addition to the requirement of weekly feedback from the family in regards to the therapist fidelity (Curtis, Ronan, & Borduin, 2004). Notably, a majority of the MST effectiveness studies were conducted with serious and violent juvenile offenders; however, since MST is able to reduce recidivism rates for juveniles with high arrest recorders it can be deduced MST’s effectiveness would be similar, if not more effective for first-time offenders.

Description of Local Services

Although the cost of addressing juvenile justice in Oklahoma is significant, that cost pales in comparison to the lifetime costs associated with juvenile delinquency. Many repeat juvenile offenders will continue offending into adulthood. The economic impact can be staggering. The total monetary cost to society of just a single lifetime of crime can reach $1.5 million (Sawyer & Borduin, 2011). The issue of course is not just about the enormous financial costs to society. One also has to consider the lost hope, dreams, and lives of many of the offenders and their possible victims.

Most first-time offenders entering the juvenile justice system in Oklahoma are referred to a third party for counseling services. Almost all referrals in Oklahoma and Cleveland counties go to Youth Services of Oklahoma County located in Oklahoma City, Mid-Del Youth and Family Center located in Del City, and Crossroads Youth and Family Services of Norman. Each of these centers is contracted with the Oklahoma Office of Juvenile Affairs to provide counseling services for juvenile offenders in the respective counties and areas. Additionally, the centers also receive juvenile offender referrals from municipal courts in the area.

The Mid-Del and Crossroads centers both utilize the same curriculum for their first-offender counseling programs. Notably, the Oklahoma Association of Youth Services developed the “First Time Offender Program” curriculum utilized by both agencies (First Time Offender Program, n.d.). The program for first-time offenders involves a total of fourteen hours of group counseling administered across eight evening sessions. The offender and at least one of their parents or guardians attend the sessions. The eight sessions are divided into these topics: Introduction to the juvenile justice system, communication, emotional regulation, smart choices, values, substance use, family systems and graduation. The entire curriculum is available for public download and was reviewed by the authors of this paper.

Although the developers of the curriculum state that parts have been designed around various evidenced based methods, the program itself has no research supporting its effectiveness. Upon review, one can see the intervention is focused upon the offenders’ personal emotions and values, coping skills, life skills, etc. One might assume the family systems unit would target family dynamics and issues between the youth and parents. However, the unit’s major emphasis is focused upon impulse control in the family setting. Virtually none of the curriculum addressed the juveniles’ environment and very little infuses is placed on interpersonal relationships with ones parent(s). Furthermore, although licensed therapists presented or oversaw the presentation of the program, one-on-one counseling is not included. With this intervention model, the empirically proven need for including environmentally based assessments in a successful intervention for first-time offenders is not included as part of the program (Henggeler, Schoenwald, & Pickrel,1995). If no change is brought to the offenders’ environment the likelihood one is driven back into old behaviors is high.

Youth Services of Oklahoma County offer a different program for first-time offenders referred by the Office of Juvenile Affairs (“Programs,” n.d.). The program is quite similar to the program at the Mid-Del and Crossroads centers. The Oklahoma County Youth Services is a sixteen-hour program instead of fourteen but is also held in the evenings at the center for the offender and their parents. Improving communication skills, making healthy choices, and basic life skills are the primary focus of the intervention. Additionally, the program was modified to incorporate the Prevention and Relationship Enhancement Program (PREP). Although PREP has been the focus of many empirical studies and shown to be highly successful as an intervention, no quantitative or qualitative research could be found supporting its use as a therapeutic intervention involving juvenile delinquency.

Although the majority of juvenile offenses occur in the urban areas of Oklahoma, what are the types of interventions available for rural offenders? One of the authors of this paper has experience in four northwest Oklahoma counties with the Office of Juvenile Affairs and the agency used for counseling services. On-site group counseling is a method urban centers use to provide services to large numbers of first-time offenders. However, rural settings present a unique problem for meeting the needs of youth in the juvenile system. For example, the Blaine county Office of Juvenile Affairs contracts with Youth and Family Services of El Reno to provide counseling to first-time offenders. Consequently, traveling to El Reno from most locations in Blaine County requires a one-way travel time of over one hour and for some towns it is over ninety minutes. Requiring youth in Blaine County to attend counseling at the El Reno facility is simply not practical.

The alternative offered for Blaine county youth, and other youth in the surrounding counties serviced by the El Reno center, is one-on-one counseling services in ones’ own town. However, due to costs and logistics, it is not possible to provide licensed therapists for the one-on-one counseling with the youthful offenders. Instead, a licensed therapist at the center oversees a group of Behavioral Health Rehabilitation Specialists (BHRS) who travel to the area towns and provide counseling services to the juvenile offenders. Although some changes are coming in 2014, in order to practice as a BHRS in Oklahoma, the only requirements are a Bachelor’s degree in any area and the passing of a simple, online test, which can be taken as many times as needed to pass. The non-profit agencies are able to call their BHRS’s “counselors” and the service they provide “counseling” because of a loophole in the Oklahoma Department of Mental Health regulations. The loophole allows for the designation of “counselor” to a BHRS if the agency’s own job description and requirements have a BHRS specified in that manner. In other words, if the wording “field counselors for Youth and Family Services must have BHRS certification” is found in the agency’s job description for the “counselor” position, the agency may rightfully call those employees counselors.

Critique of Services

Comparatively, MST has stronger empirical support and theoretical backing than the current services in central and northwestern Oklahoma in regards to addressing delinquent behavior in juveniles. On average the duration of MST is “40 hours over 15 weeks for up to 24 weeks” (Curtis, Ronan, & Borduin, 2004). Thus, participants of MST are provided with 26-24 more hours and 7 to 16 more weeks of services compared to the current services. The increased hours may be because both individual and family therapy are a part of MST unlike the current services that only focus on psychoeducation groups. Pyschoeducation can provide some very good information and skills; however, there is a lot of information to be disseminated in a short leaving very little time for the group members to absorb the information and practice the new skills. More importantly, the curriculum does not directly address each families needs but instead provides an overview of a board range of topics. Alternatively, MST is flexible and aims to provide the client and family therapy, psychoeducation on parenting and resources that will help them meet their needs (Curtis, Ronan, & Borduin, 2004). Thus the individuals and families have a longer period of time to develop new skills and allow change to occur.

Additionally, MST therapist are graduate level counselors or above that go through a rigorous training program and are provide with weekly supervisory sessions by another trained MST therapist throughout the service delivery (Henggeler, Schoenwald & Pickrel, 1995). Comparably, in rural northwestern Oklahoma youth are receiving services from BHRS’s who are not properly trained therapist. Location and time of services can hinder or benefit the probability of change for clientele. Current services require clients to meet at a specific time (i.e. nights) and place (i.e. office or conference room setting), which can present several problems for clients that do not have reliable transportation or work at night. Respectively, MST brings services to the family’s home or the youth’s school and delivered at the most convenient time for the family, not the agency (Sawyer & Borduin, 2011). Accessibility of services is extremely important and MST provides the most accessibility compared to the current services.

The A, B, C, D, F grading scale will be applied to each of the agency’s service in regards to it being a proper intervention to address juvenile delinquency. Since the Mid-Del Crossroads centers utilize similar intervention curriculum collectively the service is awarded a D. The main reason for this grade is in regards to the use of psychoeducaiton without individual and family therapy in addition to the lack of focus on each family’s individual needs. Additionally, the services are only delivered at night, in a clinical setting, and last for a short amount of time. More importantly, no research was found in regards to the reduction of delinquent behavior in juveniles. Youth Services of Oklahoma County utilizing the evidence-based program, PREP, allows it be award with a B. PREP is an respectable EBP and has strong support for its effectiveness in regards to improving relationships; however, there is no empirical research providing evidence to its effectiveness with the reduction of delinquent or antisocial behavior in juveniles. Services in northwestern Oklahoma are awarded a C because they provide both group and individual therapy to juvenile offenders. However, the fact that families may have to drive over an hour one-way to receive services is ridiculous. Moreover, the services are once again focused on the individual and not the individual and family as a whole. For the grades these services have been awarded it is not surprising that Oklahoma is ranked in the bottom ten nationally in reducing juvenile crime rates.

Change needs to happen in how Oklahoma is addressing juvenile delinquency or the juvenile crime rates will continue to increase. Since the Oklahoma Office of Juvenile Affairs dictates what services are provided in Oklahoma one needs to direct a majority of advocacy efforts at the office. Most importantly, improvements need to be made in regards to focus on the individual and family at the same time because delinquent behavior is not a one-dimensional problem. If it is unrealistic to provide each individual and their family direct services and attention then a shift toward individual therapy in conjunction with psychoeducation group with parent/caregiver(s) in attendance is strongly recommend. Additionally, agencies should look into their ability to deliver home-based services in regards to individual and family therapy over their current clinical setting. Lastly, the Oklahoma Office of Juvenile Affairs needs to be advocating for the use of EBP interventions and not be endorsing intervention without empirical support because that is unethical. Thus, it is recommended the Oklahoma Office of Juvenile Affairs look in to MST and it implementation statewide to address juvenile delinquency in Oklahoma.

Reference Page Here

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Policy Reflection

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Policy Practice Reflection Paper
Steve Weber

Nissen, L. (2006). Effective adolescent substance abuse treatment in juvenile justice settings: Practice   and policy recommendations. Child and Adolescent Social Work  Journal, 23(3), 298-315.

The purpose of this article is to increase awareness of the quality of substance abuse treatment interventions used by the juvenile justice system. Additionally, the author suggests several changes in policies that may improve substance abuse treatment outcomes within the juvenile justice system.

Today’s juvenile justice system must handle more problems than just juvenile delinquency. The current system must also work with juveniles who have substance abuse issues, mental illness, and family related problems. Due to underfunding and increased numbers of juveniles entering the system, positive intervention outcomes are decreasing; recidivism rates are rising in many states. Increasingly, the overburdened system cannot accommodate the multi-faceted needs of youth within its care. The obstacles blocking major reform are (a) poor funding, (b) negative public attitudes toward youthful offenders, and (c) current policies that are more punitive than therapeutic. Another issue that prevents the use of more evidence based interventions for treating substance abuse is the unorganized state of today’s juvenile justice system. Entities and organizations at the local, state, and federal levels often have differing policies and philosophies with respect to substance abuse treatment definitions and expected outcomes.

Compared to other available services, substance abuse treatment options are especially lacking for juvenile offenders. Fewer than 10% of youth within the juvenile justice system who need substance abuse treatment ever receive those services. Few of those youth who do receive substance abuse services participate in evidence based interventions. Although the prevalence of juvenile delinquency has decreased in the past few decades, the percentage of delinquents with substance abuse issues has dramatically increased. Studies show that the percentage of juvenile delinquents with substance abuse problems has increased approximately 300% in recent years. State and local detention policies do not usually distinguish between juvenile offenders with substance abuse disorders and those without. Therefore, and even with its current limitations, the juvenile justice system has become the largest provider of publicly funded juvenile substance abuse treatment. The juvenile justice system did not anticipate the increased number of youth who need substance abuse treatment. Only 36% of juvenile detention centers offer any type of substance abuse treatment.

The large increase in the number of delinquent youth with substance abuse issues has resulted in a lack of congruent policies among involved entities. The author suggests that standardized assessment and screening protocols should be in place for all first-time youthful offenders. Depending on the results of those assessments, evidence based interventions should initially be provided in lieu of more commonly used punitive measures. For example, Multi Systemic Therapy (MST) has strong evidence supporting its use for preventing recidivism among first time juvenile offenders. Although not originally designed for addressing substance abuse issues, studies indicate MST is also beneficial to youth with substance abuse issues. Research indicates that MST provides a solid foundation for subsequent substance abuse treatment.

More appropriate interventions will positively impact the delinquent youth themselves, their families, and society as a whole. Improved assessments and interventions for youthful offenders can lower the overall cost incurred by the juvenile and adult justice systems. Studies indicate that lower recidivism rates resulting from MST can save the juvenile and adult justice systems about $9 for every $1 invested in providing the intervention. Although long-term savings are evident, the initial costs for implementing more favorable interventions are substantial and will require shifts in agency and public attitudes in order to provide the additional funding.

Insight One: Appropriate substance abuse treatment for youth within the juvenile justice system is rare. Application One: When I become a social worker, I will likely have clients with substance abuse issues sent to juvenile detention centers. I will follow-up with their caseworker to ensure they are getting proper treatment if needed.

Insight Two: I became more aware of the theory involved in MST. Application Two: Although MST requires specific training for therapists who practice it, I believe I can and will incorporate aspects of its theory into my future practice. Specifically, when working with a delinquent youth, I will do my best to incorporate the youth’s family into the process as much as possible.

Insight Three: Punitive consequences are more common than therapeutic interventions for youthful offenders. Application Three: As a future social worker, I will have regular interactions with juvenile and court officials. I will point out to them the ineffectiveness of punitive consequences compared to more appropriate interventions and consequences considering their ages and offenses.

Insight Four: Public opinion is a major obstacle to juvenile justice policy changes. Application Four: I will advocate for changes as much as possible while I am a busy student. However, I will use my future MSW credentials as a platform for more authoritative advocacy as I speak to community groups in my community concerning the problem.

Insight Five: I learned that MST also provides a good foundation for future substance abuse treatments for youth.   Application Five: I will learn more about this aspect of the theory and possibly incorporate parts of it in interventions with my youthful clients who have substance abuse issues.


Migdole, S., & Robbins, J. (2007). Commentary: the role of mental health services in preadjudicated       juvenile detention centers. Journal of the American Academy of Psychiatry and the Law, 35(2),      168-171.

The authors’ purpose of the article is to describe the history and shortcomings of current policies for providing mental health services to preadjucdicated youth in juvenile detention centers. The authors also describe the positive steps taken in recent years for providing mental health services to offending youth.

The authors believe it is important to understand past policies regarding juvenile justice. There were four basic stages. Before 1960, judges were utilized as the parental figures for delinquent youth. Once a youth was arrested, a judge was seen as the primary figure for determining what was best for the offending youth. A shift to due process and a focus on personal rights for youthful offenders began in the 1960’s and continued until the early 1990’s. Court appointed attorneys were first appointed during that time in order to protect the youth’s rights in judicial proceedings. The next phase included a fundamental change in attitude toward juvenile delinquents. A rapid rise in the numbers of offending youth occurred in the 1990’s. There were also instances of great attention placed on young and dangerous super-predators of the time. Beginning in the 1990’s, juvenile detention centers became overwhelmed with the increased incidence and severity of delinquency. Policy makers increasingly believed that some youths could not be rehabilitated. This attitude led to policies of warehousing youth in juvenile detention centers in order to protect society from dangerous behavior. Variations of this attitude are still prevalent today and are hindering progress for forming more effective policies.

Beginning around 2000, policies began to shift from a detention mentality to more proactive policies for providing more community based behavioral and mental health services to youth. Although the current initiatives and goals are worthy, the authors describe how disjointed the efforts have been. There is not a focused effort or plan among organizations and agencies for providing mental health treatment to youth before or after they are placed in detention. The many state and local agencies that provide services utilize varied methods and philosophies. For this reason, and due to limited funding for adequate research, it has been difficult to establish many evidence based practices that current funding policies can provide for.

The questions of which youth have mental health treatment needs and the definition of treatment itself further compound the issue. If the Diagnostic and Statistical Manual of Mental Disorders (DSM) is used as a screening tool to determine the psychotherapeutic needs of offending youth, an estimated 75% of juvenile delinquents can be diagnosed with at least one mental disorder. If these standards are used to determine which youth need treatment, supplying appropriate mental health services to that size of population is not feasible with today’s available resources. In fact, an overly optimistic expansion of available resources could not adequately provide services to that number of youth. The definitions of need, treatment, or both, must be reevaluated.

The authors describe a screening tool named The Massachusetts Youth Screening Instrument (MAYSI) that is now used successfully in some states to properly validate the mental health needs of preadjudicated youth. A valid screening tool, such as the MAYSI, can better pinpoint where to focus resources in order to improve the results of currently available mental health interventions. Although not a total solution, better screening tools could result in higher quality and more personalized interventions with respect to the available resources.

State and local policies are slowly changing to help ensure youth receive the mental health services they need. However, continued progress depends upon increased cooperation between the various agencies as they seek viable solutions for providing effective solutions. Increased cooperation is also necessary in order to develop evidence based interventions as models that can be replicated within all juvenile justice centers.

Insight One: I now understand how the practice of often “warehousing” youth came about. Application One: In the past, I was a member of Blaine County’s Granduated Sanctions Committee (for handling first time youthful offenders). I will join the committee again in the future and advocate more often for supplying mental health services to youthful offenders at the time of their first offense.

Insight Two: Using the DSM alone is not a viable method for assessing youthful offenders’ mental health needs. Application Two: I have obtained an article concerning the validity of the Massachusetts Youth Screening Instrument. I will study it and determine how it, or components of it, might be applied in my county. If it appears useful and practical, I will suggest it to the Graduated Sanctions Committee in the future.

Insight Three: The article reinforced for me the need to clarify the definition of the term “treatment”. The authors reminded me how often the term is used without clear meaning. Application Three: When counseling is suggested for a youth during future meetings of Graduated Sanctions, I will address the issue of the level of treatment. For example, I will find out if the youth’s counseling will involve an LPC or LCSW or if the counseling be with an agency that uses undergraduate degreed individuals as counselors (which is often the case).

Insight Four: Juvenile justice centers are primarily focused on housing youth safely. Application Four: In the future, when I have clients go to detention, I will advocate for them with their juvenile officers to help ensure that they receive necessary counseling while in detention.

Insight Five: Methods and policies for handling young offenders differ widely by location and organization. Application Five: I will become familiar with juvenile delinquency policies and procedures in other counties near my own. If I believe aspects of their policies would prove beneficial to my county’s youth, I will advocate for changes through the Graduated Sanctions Committee.


Myers, D., & Farrell, A. (2008). Reclaiming lost opportunities: Applying public health models in juvenile   justice. Children and Youth Services Review, 30(10), 1159-1177.

The purpose of the article is to compare the original intent of the U.S. juvenile justice system with currently implemented policies. Additionally, the authors propose a strategy for modifying the system so it is more congruent with its original intent.

The legal system in the United States changed in 1899 with respect to how juvenile offenders were treated. Before that time there was no separation between adults and juveniles in the criminal court system. Additionally, before the juvenile justice system was established, youthful and adult offenders were often imprisoned in the same facilities. The rationales behind the policy changes were that rehabilitating juveniles was easier because they were still developing and that extenuating circumstances in their environment could be the cause of their misbehavior. On the other hand, adult offenders were thought of as already well ingrained with their antisocial behavior and were solely responsible for their behaviors. Separate judicial systems were created with the belief that juveniles could and should be rehabilitated during their developmental stages. Additionally, housing juveniles and adult offenders together in the same prisons created problems and was cause for concern at the time.

Despite the original focus for rehabilitating youth, today’s system is moving further away from that focus to one that is more punitive. This shift is evident by the increasing number of youth in detention even though the prevalence of violent crimes committed by youth has decreased in recent decades. The public’s fear of high profile youthful offenders is one reason the policies are more punitive than in prior years. The increased rate is also due to the current policy of using detention as punishment for such things as chronic truancy and running away from home. A case can be made that the juvenile justice system has criminalized family dysfunction.

The authors propose that juvenile delinquency should be considered as a public health concern. This perspective would allow for the implementation of a true medical model. Although certain aspects of current juvenile justice policies loosely follow a medical model perspective, the punitive side of the system negates the positive aspects of any medical model focus. A true medical model would include broad preventative measures focused on the entire population of youth. In addition, highly targeted preventative measures should be applied to all high-risk segments of youthful populations. Finally, when delinquency occurs despite the application of preventative measures, evidence based interventions and services should be provided to offending youth on a personal and customized basis. The medical model approach would remove many of the punitive components within the current juvenile justice system. Although a true medical model represents a change in philosophy, it does not mean that detention for some offending youth would cease to exist. Instead, the medical model would utilize detention, when required for the safety of the youth or society, as one aspect of a highly targeted intervention still focused on rehabilitation.

The proposed medical model for the juvenile justice system includes (a) strengths and needs based approaches, (b) active involvement of the family, (c) cooperation and collaboration among involved agencies, (d) flexible and highly individualized services in natural settings, and (e) focus on community and cultural context. When the punitive aspects of today’s policies are removed and replaced with a true medical model, lower offending and recidivism rates will occur. This fact is documented by research studies involving several communities that have implemented a very structured medical model within their juvenile justice system. Not only does the medical model result in decreased delinquency and recidivism rates, the medical model offers communities significant financial savings with respect to detention costs and associated expenditures. However, perhaps the most important benefit achieved with a true medical model is the overall increase of the quality of life for the offending youth, their families, and the community as a whole.

Insight One: I was surprised to learn that the original juvenile justice system was less punitive than today’s system. Application One: As I stated earlier, in the future I will have frequent contact with juvenile and county court officials. I will remind these officials, whenever possible, of the need for rehabilitation in lieu of punishment.

Insight Two: Applying a true medical model to the juvenile justice system is a more logical approach. Application Two: From my past experience, I can see how many at-risk youth progress to the offending stage while receiving few, if any, preventative services. As a future social worker in my community, I will address this lack of services with the local committees and organizations I belong to.

Insight Three: I was aware youth could be sent to detention for excessive truancy. However, I never thought about it before in the context of how that action criminalizes youth due to family dysfunction. Application Three: In the past I have been in court with truant youth who faced possible detention. When I am in that situation again, I will use a more grounded understanding for how wrong it is to use detention for such purposes.

Insight Four: Multi Systemic Therapy is an important component of a medical model for the juvenile justice system. Application Four: In my future practice,I will incorporate the therapy’s basic theory for involving a delinquent youth’s family in the therapeutic process as much as possible.

Insight Five: Applying a medical model to the juvenile justice system requires cooperation between the various involved agencies. Application Five: From my prior experiences I can attest to how often agencies do not have sufficient collaboration and cooperation with each other. While serving on various community committees in the future, I will use my increased skill as a social worker to find ways to increase collaboration and cooperation.

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