SOCW 6111 WEEK 7

 

Week 7: Tools for Practice

As an intern, even in your concentration year, it is common and expected to be nervous and unsure when you begin to work with clients. Working one-on-one with a client requires many skills that take years to learn and a feeling of mastery over these skills is a misguided goal. As a social work professional, even after you graduate, you will learn many lessons from your clients. You will consistently be challenged to obtain new skills and knowledge to best assist your clientele. Further, you will constantly be asked to look at yourself and your own reactions when providing care to your clients. The use of self-reflection and self-awareness is required of a good social worker who recognizes his or her own potential biases and personal experiences in and out of the room. This week you will consider some potential barriers to successfully working with a client and some potential strategies to address them.

Learning Objectives

Students will:

• Explain the importance of identifying internal and external barriers
• Analyze barriers to a therapeutic relationship
• Apply self-disclosure as an intervention strategy

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Drinane, J. M., Owen, J., & Tao, K. W. (2018). Cultural concealment and therapy outcomes. Journal Of Counseling Psychology, 65(2), 239-246.
Geller, S. M., & Greenberg, L. S. (2012). Challenges to therapeutic presence. In Therapeutic presence: A mindful approach to effective therapy (pp. 143–159). Washington, DC: American Psychological Association.
McTighe, J. P. (2011). Teaching the use of self through the process of clinical supervision. Clinical Social Work Journal, 39(3), 301–307.
Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014a). Sessions: case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
The Petrakis Family (pp. 20–22)

Required Media

Laureate Education (Producer). (2013c). Petrakis family: Episode 3 [Video file]. Retrieved from

https://class.waldenu.edu

Accessible player –Downloads–Download Video w/CCDownload AudioDownload TranscriptCredit: Provided courtesy of the Laureate International Network of Universities.
Singer, J. B. (Host). (2007, March 1). Developing treatment plans: The basics [Episode 10]. Social Work Podcast. Podcast retrieved from http://socialworkpodcast.com/2007/03/developing-treatment-plans-basics.html

Optional Resources

Use this link to access the MSW home page, which provides resources for your social work program.

Discussion 1: Self-Reflection and Awareness

Exploring the reasons for wanting to be in social work and examining your motives for choosing a career of helping others is very important. Your background, including childhood experiences, may be instrumental in bringing you into the field of social work. Understanding the possible connection and working to resolve any underlying unresolved issues is essential to becoming an effective social worker. While working with a client, you must strive to be objective, but in the end we are all human with past hurtful experiences that can impact our ability to effectively work with clients. While complete objectivity is impossible and not expected, it is necessary to self-reflect and become aware of when a situation or a certain personality type causes you to react in an unprofessional manner. Understanding potential internal and external barriers you and your client bring to the room will assist you in balancing an appropriate empathetic response with proper objectivity.

For this Discussion, review the Geller & Greenberg (2012) article and the program case study for the Petrakis family, and view the corresponding video.

By Day 3

Post your explanation of the importance of identifying internal and external barriers of the client and social worker. Then describe the barriers experienced by Helen and the social work intern. Finally, suggest ways the intern could overcome these barriers.

Support your posts with specific references to the Learning Resources. Be sure to provide full APA citations for your references.

By Day 5

Respond to at least two colleagues and suggest alternate ways the intern might overcome barriers.

Support your responses with specific references to the Learning Resources. Be sure to provide full APA citations for your references.

Submission and Grading Information

Grading Criteria

To access your rubric:
Week 7 Discussion 1 Rubric

Post by Day 3 and Respond by Day 5

Responses

 larry harris RE: Discussion 1 – Week 7

COLLAPSE

Client and therapist relationships are influenced by internal and external barriers.  According to Geller and Greenberg although we categorize challenges as internal and external those external challenges are internal for the therapist and must be worked through (2012).  As therapist we need to be aware of self to fully be in the moment when working with clients.  “To access that inner steadiness we have to commit to riding through our own inner terrain with greater ease and assurance, while being a part of a something larger, whether it be a sense of community or through spirituality (Geller and Greenberg, 2017, p. 150).  Being aware of self lets us know the areas we need improvement and focus.

In the case of The Petrakis Family the intern was trying to help Helen brainstorm solutions to the caring for Magda.  She is now being blamed for the entire situation with the grandson stealing from Magda.  Helen trying to protect Alec and his image withheld information from the social worker allowing the social worker to suggest things.  Helen internally is conflicted with not only telling the social worker about Alec but telling her husband what has happened.   The social worker needs to figure out a way to calm the situation and speak with her supervisor to make sure she has done everything correctly.  I think the social worker should have included Magda in the session before allowing Helen to make that decision about letting Alec move in. 

References

 Geller, S. M., & Greenberg, L. S. (2012). Challenges to therapeutic presence. In Therapeutic presence: A mindful approach to effective therapy. (pp. 143–159). Washington, DC: American Psychological Association. 

https://doi-org.ezp.waldenulibrary.org/10.1037/13485-008

Laureate Education (Producer). (2013c). Petrakis family: Episode 3 [Video file]. Retrieved from https://class.waldenu.edu

Response 2

 Sara Hale RE: Discussion 1 – Week 7COLLAPSE

Internal barriers are something within you that prevents you from reaching your goals, such as personality, or personal beliefs while external barriers are something in your environment that prevents you from achieving your goal, such as resources, people or job (Garthwait, 2017).   One of the main internal barriers that client and social worker in this case, is lack of rest, which affects most of the previous mentions (Garthwait, 2017). External barriers are less controllable.  By have expectations of others, time commitments, inefficiencies in the system, rules and regulations, something simple like too much information to absorb, or lack of kindred spirit, someone to talk to about ideas (Garthwait, 2017). To overcome some of these barriers the social worker and the client would need to understand what the barriers are to be aware of them..

When it comes to Helen and the social worker intern Helen stereotyped the intern by asking her age and assuming she is too young to do the job (Laureate Education, 2013c).  Helen has emotional barriers and taboos.  Helen was uncomfortable talking about her life with a stranger and was not sure about coming in for therapy.   Helen had expectations and prejudices which may lead to false assumptions or stereotypes.  People often hear what they expect to hear rather than what is said and jump to incorrect conclusions.  With Helen being in a psychological state the communication will influence how the message is sent, received and perceived.  Helen was demonstrating this by blaming the intern for being too young and not knowing what she is doing, instead of realizing that there was miscommunication on what Helen’s options were(Need, 2016).

First, the intern should not take it personally (although it’s hard not to sometimes).  The intern can learn from this session and make sure she changes things for the next.  The intern can ask for clarification if she does not understand why Helen was so hesitant to have her son help out with his grandmother.  The intern could do this by using reflective listening and also use open-ended questions to get more of the situation than just what Helen is giving at the time.

References

Garthwait, C. L. (2017). The social work practicum: A guide and workbook for students (7th ed.). Upper Saddle River, NJ: Pearson.

Laureate Education (Producer). (2013c). Petrakis family: Episode 3 [Video file]. Retrieved from https://class.waldenu.edu

Need, S. (2016). An introduction to communication skills: The skills you need guide to interpersonal skills. UK: Skills You Need.

Response 3

 Raven Jones RE: Discussion 1 – Week 7COLLAPSE

Countertransference is defined as “the therapist’s internal or external reactions that are shaped by the therapist’s past or present emotional conflicts and vulnerabilities” (Gelso & Hayes, 2007, p. 25) . Being in my second semester of field placement and working full time at a mental and behavioral hospital, I myself have experience countertransference when working with clients. For example, I have had bad experiences with a past client and when working with present clients my attitude towards them would strain from the past situation. I became self aware of this and knew I had to make a change in my approach. The first thing that I did was recognize I worked for two different populations. Secondly I knew I couldn’t project my experience unto new clients especially when I haven’t built rapport them. Helen and the social worker are experiencing a countertransference as well. Helen is verbally aggressive towards the social worker due to her stress and emotions.  Geller & Greenberg stated that being aware of one’s self and the other, in the way that therapeutic presence evokes, allows therapists to recognize countertransference reactions when they do emerge and either work with them internally to let them go and not act them out or use them in a positive therapeutic manner to reflect what the client is experiencing or may be evoking in the other (pp.145). After that session, the social worker in this case should decide how to move forward with Helen.

Geller,S.M., & Greenberg, L.S. (2012). Challenges to therapeutic presence. In Therapeutic presence: A mindful approach to effective therapy (pp. 143-159). Washington, DC: American Psychological Association.

Discussion 2: Self-Disclosure

Knowing that clients might react negatively to your work with them may cause anxiety, frustration, and even anger. It is inevitable that you will work with a client who expresses anger or disappointment over working with you. This does happen in the social work field and is to be expected over time. Understanding how you might react to allegations of incompetence or anger over incomplete goals is essential to managing this type of exchange. While a negative interaction may be justified if either person did not fulfill responsibilities, often it is a result of the client’s personal reaction to the situation. The best response is to use these interactions to build the therapeutic bond and to assist clients in learning more about themselves. Stepping back to analyze why the client is reacting and addressing the concern will help you and the client learn from the experience.

For this Discussion, review the program case study for the Petrakis family.

By Day 4

Post a description of ways, as Helen’s social worker, you might address Helen’s anger and accusations against you. How might you feel at that moment, and how would you maintain a professional demeanor? Finally, how might you use self-disclosure as a strategy in working with Helen?

Support your posts with specific references to the Learning Resources. Be sure to provide full APA citations for your references.

By Day 6

Respond to at least two colleagues who suggested a different strategy and suggest different approaches to working with Helen.

Response 1

 Britney Fallen RE: Discussion 2 – Week 7COLLAPSE

By using the accusations and the anger Helen is feeling to teach and build from can be a pivotal moment in treatment. Although being accused of such a negative thing would feel awful. In order to maintain professionalism I would have to demonstrate thick skin. It is important to actively listen to Helen and let her say what she needs to say. As the social worker I would maintain a professional demeanor by remaining calm, accepting what she is feeling, and empathizing. According to the Clinical Social Work Journal, It is important to maintain an environment that Helen can voice her opinions and perspectives (2011). When Helen has calmed down we can analyze why she reacted this way with projecting blame onto others and what is actually bothering her. Her son is stealing from her mother in law as well as other factors building up in her life. This isn’t the social workers fault or even Helen’s fault. Helen did what she thought was best for both of them at that time.

After analyzing the circumstances maybe Helen can learn from the situation. The social worker could even learn from the situation as it was forgotten to take Magda’s perception and needs into consideration. Furthermore, according to the NASW, self-disclosure can be used appropriately and selflessly when it is used to advance the clients well-being (2008). For example, if I relate to Helen directly and inform her of a time that I used a negative situation and learned from it. This could aid in restoring the relationship that was distressed. This example could also model similar situation in order to grow. Maintaining an open welcoming environment for Helen will encourage growth and change within the working relationship and her treatment measures.  

References:

McTighe, J. (2011). Teaching the Use of Self through the Process of Clinical Supervision. Clinical Social Work Journal, 39(3), 301–307.

https://doi-org.ezp.waldenulibrary.org/10.1007/s10615-010-0304-3

National Association of Social Workers. (2008). Code of ethics of the National Association of social workers. Retrieved from http://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english

Response 2

 Nakesha Morgan RE: Discussion 2 – Week 7COLLAPSE

I will remain in a professional tone.   I will inform Helen that I understand her frustration and how the issues may be stressing her out.  I will maintain a professional demeanor by not reacting with body language or change of tone.  I would remain in a the same manner as before Helen became irate.   As a worker in this situation to prevent something like that occurance I would to ensure to look further into the individual whom is recommended for a caregiver.

When it comes to self disclosure I would wait for Helen to calm down and I will state my credentials and training to her and ensure her that my age has noting to do with my position as a worker.   Self disclosure can be used in an appropriate manner when it is used to advance the client’s well being (NASW, 2008).  Maintaining a professional demeanor with a comfortable setting will help the worker/client relationship to better assist with outcomes.  It is important that a client has an environment to express their opinions (McTighe, 2011).

Laureate Education (Producer). (2013c). Petrakis family: Episode 3 [Video file]. Retrieved from https://class.waldenu.edu
National Association of Social Workers. (2008). Code of ethics of the National Association of social workers. Retrieved from http://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english

McTighe, J. (2011). Teaching the Use of Self through the Process of Clinical Supervision. Clinical Social Work Journal, 39(3), 301–307. https://doi-org.ezp.waldenulibrary.org/10.1007/s10615-010-0304-3

The Petrakis Family

Helen Petrakis is a 52-year-old heterosexual married female of Greek descent who says that she feels overwhelmed and “blue.” She came to our agency at the suggestion of a close friend who thought Helen would benefit from having a person who could listen. Although she is uncomfortable talking about her life with a stranger, Helen said that she decided to come for therapy because she worries about burdening friends with her troubles. Helen and I have met four times, twice per month, for individual therapy in 50-minute sessions.

Helen consistently appears well-groomed. She speaks clearly and in moderate tones and seems to have linear thought progression; her memory seems intact. She claims no history of drug or alcohol abuse, and she does not identify a history of trauma. Helen says that other than chronic back pain from an old injury, which she manages with acetaminophen as needed, she is in good health.

Helen has worked full time at a hospital in the billing department since graduating from high school. Her husband, John (60), works full time managing a grocery store and earns the larger portion of the family income. She and John live with their three adult children in a 4-bedroom house. Helen voices a great deal of pride in the children. Alec, 27, is currently unemployed, which Helen attributes to the poor economy. Dmitra, 23, whom Helen describes as smart, beautiful, and hardworking, works as a sales consultant for a local department store. Athina, 18, is an honors student at a local college and earns spending money as a hostess in a family friend’s restaurant; Helen describes her as adorable and reliable.

In our first session, I explained to Helen that I was an advanced year intern completing my second field placement at the agency. I told her I worked closely with my field supervisor to provide the best care possible. She said that was fine, congratulated me on advancing my career, and then began talking. I listened for the reasons Helen came to speak with me.

I asked Helen about her community, which, she explained, centered on the activities of the Greek Orthodox Church. She and John were married in that church and attend services weekly. She expects that her children will also eventually wed there. Her children, she explained, are religious but do not regularly go to church because they are very busy. She believes that the children are too busy to be expected to help around the house. Helen shops, cooks, and cleans for the family, and John sees to yard care and maintains the family’s cars. When I asked whether the children contributed to the finances of the home, Helen looked shocked and said that John would find it deeply insulting to take money from his children. As Helen described her life, I surmised that the Petrakis family holds strong family bonds within a large and supportive community.

Helen is responsible for the care of John’s 81-year-old widowed mother, Magda, who lives in an apartment 30 minutes away. Until recently, Magda was self-sufficient, coming for weekly family dinners and driving herself shopping and to church. But 6 months ago, she fell and broke her hip and was also recently diagnosed with early signs of dementia. Through their church, Helen and John hired a reliable and trusted woman to check in on Magda a couple of days each week. Helen goes to see Magda on the other days, sometimes twice in one day, depending on Magda’s needs. She buys her food, cleans her home, pays her bills, and keeps track of her medications. Helen says she would like to have the helper come in more often, but she cannot afford it. The money to pay for help is coming out of the couple’s vacations savings. Caring for Magda makes Helen feel as if she is failing as a wife and mother because she no longer has time to spend with her husband and children.

Helen sounded angry as she described the amount of time she gave toward Magda’s care. She has stopped going shopping and out to eat with friends because she can no longer find the time. Lately, John has expressed displeasure with meals at home, as Helen has been cooking less often and brings home takeout. She sounded defeated when she described an incident in which her son, Alec, expressed disappointment in her because she could not provide him with clean laundry. When she cried in response, he offered to help care for his grandmother. Alec proposed moving in with Magda.

Helen wondered if asking Alec to stay with his grandmother might be good for all of them. John and Alec had been arguing lately, and Alec and his grandmother had always been very fond of each other. Helen thought she could offer Alec the money she gave Magda’s helper.

I responded that I thought Helen and Alec were using creative problem solving and utilizing their resources well in crafting a plan. I said that Helen seemed to find good solutions within her family and culture. Helen appeared concerned as I said this, and I surmised that she was reluctant to impose on her son because she and her husband seemed to value providing for their children’s needs rather than expecting them to contribute resources. Helen ended the session agreeing to consider the solution we discussed to ease the stress of caring for Magda.

The Petrakis Family

Magda Petrakis: mother of John Petrakis, 81

John Petrakis: father, 60

Helen Petrakis: mother, 52

Alec Petrakis: son, 27

Dmitra Petrakis: daughter, 23

Athina Petrakis: daughter, 18

In our second session, Helen said that her son again mentioned that he saw how overwhelmed she was and wanted to help care for Magda. While Helen was not sure this was the best idea, she saw how it might be helpful for a short time. Nonetheless, her instincts were still telling her that this could be a bad plan. Helen worried about changing the arrangements as they were and seemed reluctant to step away from her integral role in Magda’s care, despite the pain it was causing her. In this session, I helped Helen begin to explore her feelings and assumptions about her role as a caretaker in the family. Helen did not seem able to identify her expectations of herself as a caretaker. She did, however, resolve her ambivalence about Alec’s offer to care for Magda. By the end of the session, Helen agreed to have Alec live with his grandmother.

In our third session, Helen briskly walked into the room and announced that Alec had moved in with Magda and it was a disaster. Since the move, Helen had had to be at the apartment at least once daily to intervene with emergencies. Magda called Helen at work the day after Alec moved in to ask Helen to pick up a refill of her medications at the pharmacy. Helen asked to speak to Alec, and Magda said he had gone out with two friends the night before and had not come home yet. Helen left work immediately and drove to Magda’s home. Helen angrily told me that she assumed that Magda misplaced the medications, but then she began to cry and said that the medications were not misplaced, they were really gone. When she searched the apartment, Helen noticed that the cash box was empty and that Magda’s checkbook was missing two checks. Helen determined that Magda was robbed, but because she did not want to frighten her, she decided not to report the crime. Instead, Helen phoned the pharmacy and explained that her mother-in-law, suffering from dementia, had accidently destroyed her medication and would need refills. She called Magda’s bank and learned that the checks had been cashed. Helen cooked lunch for her mother-in-law and ate it with her. When a tired and disheveled Alec arrived back in the apartment, Helen quietly told her son about the robbery and reinforced the importance of remaining in the building with Magda at night.

Helen said that the events in Magda’s apartment were repeated 2 days later. By this time in the session Helen was furious. With her face red with rage and her hands shaking, she told me that all this was my fault for suggesting that Alec’s presence in the apartment would benefit the family. Jewelry from Greece, which had been in the family for generations, was now gone. Alec would never be in this trouble if I had not told Helen he should be permitted to live with his grandmother. Helen said she should know better than to talk to a stranger about private matters.

Helen cried, and as I sat and listened to her sobs, I was not sure whether to let her cry, give her a tissue, or interrupt her. As the session was nearing the end, Helen quickly told me that Alec has struggled with maintaining sobriety since he was a teen. He is currently on 2 years’ probation for possession and had recently completed a rehabilitation program. Helen said she now realized Alec was stealing from his grandmother to support his drug habit. She could not possibly tell her husband because he would hurt and humiliate Alec, and she would not consider telling the police. Helen’s solution was to remove the valuables and medications from the apartment and to visit twice a day to bring supplies and medicine and check on Alec and Magda.

After this session, it was unclear how to proceed with Helen. I asked my field instructor for help. I explained that I had offered support for a possible solution to Helen’s difficulties and stress. In rereading the progress notes in Helen’s chart, I realized I had misinterpreted Helen’s reluctance to ask Alec to move in with his grandmother. I felt terrible about pushing Helen into acting outside of her own instincts.

My field instructor reminded me that I had not forced Helen to act as she had and that no one was responsible for the actions of another person. She told me that beginning social workers do make mistakes and that my errors were part of a learning process and were not irreparable. I was reminded that advising Helen, or any client, is ill-advised. My field instructor expressed concern about my ethical and legal obligations to protect Magda. She suggested that I call the county office on aging and adult services to research my duty to report, and to speak to the agency director about my ethical and legal obligations in this case.

In our fourth session, Helen apologized for missing a previous appointment with me. She said she awoke the morning of the appointment with tightness in her chest and a feeling that her heart was racing. John drove Helen to the emergency room at the hospital in which she works. By the time Helen got to the hospital, she could not catch her breath and thought she might pass out. The hospital ran tests but found no conclusive organic reason to explain Helen’s symptoms.

I asked Helen how she felt now. She said that since her visit to the hospital, she continues to experience shortness of breath, usually in the morning when she is getting ready to begin her day. She said she has trouble staying asleep, waking two to four times each night, and she feels tired during the day. Working is hard because she is more forgetful than she has ever been. Her back is giving her trouble, too. Helen said that she feels like her body is one big tired knot.

I suggested that her symptoms could indicate anxiety and she might want to consider seeing a psychiatrist for an evaluation. I told Helen it would make sense, given the pressures in her life, that she felt anxiety. I said that she and I could develop a treatment plan to help her address the anxiety. Helen’s therapy goals include removing Alec from Magda’s apartment and speaking to John about a safe and supported living arrangement for Magda.