Clinical Social Work

Clinical Social Work

Client/Client System

Professional Setting

Doing my hospice field placement, I got an opportunity to be attached to a rehabilitative center, specifically at the care conference. Here we handle patients/clients in the discharge phase. We prepare patients and other members, ensuring they are comfortable, safe, and understand all it takes to be discharged to their various settings. Therefore, we are meant to unveil the reality behind the patient’s condition, progress, and even possible outcome. This elicits different reactions from the clients, which we have to intervene appropriately, especially in the provision of psychosocial support.

Client Information

The client, in this case, the scenario is 60 years old a black American female. She is a single mother of two, an elder son and younger daughter. As the breadwinner of the family, the mother used to be a businesswoman before falling sick. The son just finished college while the daughter is the second year in college. The history of drinking alcohol could be retrieved from the previous medical data. The history of smoking was adverse.

Presenting Problem

The patient came to the facility as a personal referral from home, accompanied by both children. Therefore, she was admitted voluntarily under her consent and those of her children. According to records, the mother was diagnosed with Dementia three years ago. According to DSM V diagnostic criteria, Dementia falls under neurocognitive disorders coded Code F03.9. It is associated with long term gradual loss of memory accompanied with emotional symptoms and decreased motivation among other cognitive functions. Usually, the condition does not affect a person’s consciousness.

The mother reportedly was under medication, and psychiatric outpatient clinic follows up at a nearby facility. At first, her condition improved until she resumed her regular duties. However, with time, her condition deteriorated gradually. The daughter reports of worse episodes erupting in between, which could resolve, 2 of which resulted in readmission. Despite continuing with medication, her condition deteriorated to the extent of her being confused, showing signs of withdrawal or depression, and wandering away from home, which prompted them to visit the rehabilitation center.

 Relevant Background

According to Livingston et al. (2017), Black Americans have an increased risk of developing Dementia. The disease is common with increased age due to abnormal aging of vessels (atherosclerosis), reducing blood supply to the brain. Obese individuals have increased chances due to increased risk of accumulation of cholesterol in the blood vessels. Sedentary lifestyle, smoking, among other underlying conditions such as hypertension and diabetes, also predisposes one to Dementia (Livingston et al. 2017). For our case, Dementia may be as a result of age and high BMI related to inactivity.

Selected Segment of a Session

Unveiling the reality concerning the prognosis of the condition was the most challenging part. This was based on the fact that Dementia is a progressive condition that gets one’s health deteriorates with time despite measures put in place (Livingston et al. 2017). So, during the session, when I tried to bring the reality by saying, “mom is going to get worse with dementia because it is a progressive condition.” This made the son explode, faulting the facility of claiming the mum had Dementia. This was problematic because it raised the level of anxiety instead of alleviation. Therefore, the process of discussing the plan of care of the patient even as they were being discharged home was distorted. Based on the diagnosis, the trust of the son on the facility and the care team reduced. Therefore, it called for another level of discussion to convince him of His mother’s condition as well as make him trust the information and care plan provided by the facility team.

Therapy and rationale

Family systems therapy is based on the view that a family is an emotional unit. In system thinking, parts of the system ought to be evaluated to the whole. The same notation is applicable when handling matters concerning the family system. The original functioning of the family as a whole determines individual behaviors at any given point. According to Flaskas (2018), family systems therapy is a helpful approach when a conflict comes up due to family unit experiences. 

The family systems therapy is based on family systems theory by Murray Bowen (Johnson, & Ray, 2016). According to the theory, the family is defined by a network of relations that make individuals inseparable. According to Bowen, even therapists have, in one way or another, experienced challenges related to the family. Having this awareness enables the therapists to normalize behaviors of individuals who have been affected due to various conditions affecting the family, according to Bowen’s theory. Two family aspects need to be addressed as a broader way of solving challenges in the family system. The two elements include structure and behavior (Yalom, Irvin, Leszcz, Molyn, 2005). 

Different forms of family therapies are based on family systems theory. It is the family systems therapy that we subdivided into strategic, structural, and intergenerational family therapies (Kim-Appel & Appel, 2015). Under structural treatment, family relationships, patterns, and even behaviors that may lead to the current practices are assessed and evaluated. Subsystems within the family system, such as siblings and parenting, are also exploited. Under strategic family therapy, the therapist seeks to understand factors such as mode of communication, problem-solving patterns, which can help them come up with paradoxical interventions. In intergenerational family therapy sessions, generational factors that may influence individual behavior are sought out. Behavior patterns, such as reaction to bad news, management of anxiety, among others, may help the therapist understand what to expect and the best way to approach the current situation (Yalom, Irvin, Leszcz, Molyn. 005). Therefore, through intergenerational family therapy sessions, individuals of a family can be assisted in overcoming a challenge through discussion of similar scenarios and reactions preventing accusatory statements. 

In my family counseling session, I chose to go for structural family therapy. This is because, the son and daughter needed to readapt to the change of condition of their mother, who was part of the family unit. The state would interfere with their healthy relation, operation, family organization, and behaviors. As the children of the home, they would be required to chip in a little bit more and help their mother carry out daily activities that would be halted due to her condition. They would also need to figure out how to cater to family expenses now that the disease process enabled the breadwinner. However, the daughter and son were affected, were still in the denial stage, hence would not be able to undergo the structural therapy effectively. Therefore, there was a need for me to use intergenerational therapy first in understanding how they would react to such news. This would have helped me to handle the situation better with less misunderstanding and anxiety.

On the other side, grief theory would also be applicable in managing the situation. According to Freud, founder of grief theory, grief is an adaptive mechanism that comes in response to loss. It is not merely an expression of emotional pain (Stroebe, Boerner, & Schut, 2017.). The theory emphasizes that it is wrong to expect individuals to resume a healthy life immediately after an incidence. Grieving is a process, and different individuals go through the stages differently. All individuals ought to be allowed to under all the methods. 

Analysis of Segment

Ellen Wachtel’s book is grounded on understanding what makes intimate relationships succeed. It is through understanding these relationships that a therapist can come up with a therapeutic intervention that would motivate the clients to alter patterns and build on strengths despite what the challenge is (Wachtel, 2005). According to the author, there are unrecognized choices that therapists face throughout the session and fail to identify their implications. 

In the problematic segment, I was not keen to identify it was appropriate to use both types of family therapies. I only had the best interest of the mother and left out the two children who happened to be affected most. It is through such an oversight that I ended up choosing a structural family type of therapy over combined. Ideally, the intergenerational kind of family therapy is helpful to the therapist. It helps the therapist understand if the same incidence has ever occurred and how the family responds or reacts to such or related news. Intergenerational type of therapy as well prepares individuals making it easy for them to absorb whatever the situation (Yalom, Irvin, Leszcz, Molyn, 2005). Therefore, for this case, the use of an integrative approach would have been most appropriate.

As for the chosen type of therapy, it caused more harm than good. It elicited denial and more anxiety and not acceptance. It would take more time and resources to settle the son and daughter before starting preparing them to receive their mother, knowing she won’t go back to the state they used to be in. Through acceptance, then the department would be sure of patient safety hence be discharged home. Therefore, given a moment back, I will use the combine family therapy method.

Countertransference happens when the therapist transfers emotions to the person in therapy (Yalom, Irvin, Leszcz, Molyn, 2005). Usually, the phenomenon occurs when the person influences the psychologist’s feelings in therapy. Wachtel (2005) had something to say about maintaining neutrality in therapy. According to him, emotional neutrality is crucial for unconditional positive regard for client situations. As for my case, I was able to avoid showing my emotions during the session. I tried not to show my frustration. I have learned to keep my emotions neutral from the experience I have heard in various scenarios occurring in the clinical area. I am convinced that as professionals, we are the people to face reality and try to make sense out of it for our clients. Therefore, I have learned to remain strong for the clients by not showing my emotions during the assessment and therapeutic intervention.

References

Flaskas, C. (2018). The therapeutic relationship in systemic therapy. Routledge.

Johnson, B. E., & Ray, W. A. (2016). Family systems theory. Encyclopedia of Family Studies, 1-5.

Kim-Appel, D., & Appel, J. K. (2015). Bowenian family systems theory: Approaches and applications. Foundations of couples, marriage, and family counseling, 185-213.

Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D.& Cooper, C. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113), 2673-2734.

Stroebe, M. S., Boerner, K., & Schut, H. A. W. (2017). Grief. Encyclopedia of Personality and Individual Differences, 2.

Wachtel, Paul L.. (2005) Psychoanalysis and behavior therapy: toward an integration New York: Basic Books,

Yalom, Irvin D., Leszcz, Molyn. (©2005) The theory and practice of group psychotherapy /New York: Basic Books,