Assessing and Working with a Client’s Capacity to Form a Therapeutic Alliance/Working Relationship

Midterm Assignment

Zenique Smith

Clinical Practice I- 6413

Professor Gerald Perna

October 20, 2018

 

Assess代写 The mission is to provide holistic and professional services in an effort to build and sustain safe families and communities.

The Agency

  My advance year field placement is at Archcare’s General Preventive Family Life Program (PPRS). The mission is to provide holistic and professional services in an effort to build and sustain safe families and communities. That promote independence and increased self-worth, self-awareness and respect (About Archcare, 2018). The General Preventive/Family Life Program is funded by The Administration for Children’s Services (ACS). The program’s staff consists of professionals with degrees in BSW, MSW Psychology or Counseling.  The program’s general eligibility requirements includes services provided to at risk families residing in the South Bronx Community District; through in-home visits with an emphasis on family focused and strength based general case management.

Services in the general preventive program may include, but are not limited to: referrals for mental health and medical care linkage, systems advocacy around housing, court, entitlements, medical, and educational needs; coordination and planning with service providers to meet the family’s needs, parenting and anger management workshops and supportive casework counseling. Assess代写**成品

My role as an intern/case planner includes conducting psychosocial and twice a month home visits, assessing family needs, support the family,  ensure the overall safety of the children and basic needs are met; linkage to community based services, monitor progress and comply with ACS, NYS and NYC regulations. The client’s responsibilities is to identify the problems, work with preventive staff to address family needs, comply with services goals or recommendations and honest communication.

Client’s Description  Assess代写

The client discussed is Ms. F, a 34-year-old Latin-American woman living in the Bronx, has been referred to Archare at Home (AH) for social service interventions intended to help her continue in her substance abuse recovery, improve her parenting skills, and maintain consistent employment. She has three living children, ages 10, 8, and 2, none of whom are currently in her custody. Her son and oldest child lives with his grandmother and is doing well developmentally and socially. Assess代写**成品

Her daughters were recently removed from her custody and placed in non-kin foster care after an incident with CPS, which resulted from a call by a neighbor that Ms. F says stemmed from a misunderstanding. She has a history of crack-cocaine use and heroin addiction. She is currently prescribed methadone and pharmacotherapy to improve her major depressive symptoms.

Positionality    Assess代写

Ms. F graduated high school and attended classes at a community college for six months before dropping out to start working. Her drug problems resulted in her being fired and she turned to prostitution to support herself. Since I am a professional pursuing a graduate degree in social work, my first goal as a social worker/case planner is to position myself in Ms. F’s mind as a gate-keeper and assistant whose sole motivation in these encounters is to provide her with the necessary resources to help her succeed. And enter a position where she is eligible to regain custody of her two daughters. Assess代写**成品

As a relatively privileged individual, I will need to remain mindful of my tendency to view education as the best tool for social mobility. And to recognize my bias regarding financial management and how Ms. F is likely struggling due to the combined stress of a potential drug relapse, insufficient monetary resources, and minimal social support.

Factors  Assess代写

Modern social work theories emphasize the interacting factors, such as personality, family environment, and cultural background. Which have impacted the behaviors of people, such as those seeking assistance from Archcare. I will work during assessment sessions to recognize the individual nature of the outcome that stems from the unique combination of these factors, so that the selected treatment can be tailored to fit Ms. F’s individual needs. Assess代写**成品

While doing so, I must also remain critically conscious of my own culture and preconceptions to mitigate potential bias and to recognize personal factors that might be hindering the development of a therapeutic relationship. It is only through this process that I can properly address the familial, environmental, and social factors that are inhibiting Ms. F’s sense of well-being without the need to pathologize her (Suarez et al, 2008).

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The Working Relationship  Assess代写

The therapeutic process depends heavily on the development of a healthy working partnership between the social worker and client.

The success of the first session with an individual seeking help at Archcare depends heavily on the ability of the social worker to properly manage the expectations of the client. This effort can be made more difficult if those expectations do not line up well with the motivations of the therapist. This type of situation can result in feelings of exasperation and frustration on the part of the therapist plus resentment and malcontent from both parties. Assess代写**成品

A good therapist will frequently remind oneself to slow down and properly address the barriers that are preventing the client from being receptive of assistance in solving the concerns that first brought them to the office. Otherwise, the negative feelings that can get passed from client to therapist and vice versa will inhibit even the best intentions and sincere efforts during therapy (Marziali, 1988).

Frequently, clients will developed barriers that hinder the formation of a working partnership.  Assess代写

Cory F. Newman (1994) suggests using the resistance to therapy displayed by the client to gain a deeper understanding of the psychosocial factors that led the client to seek assistance. When this information is properly assessed, it strengthens the therapeutic relationship and improves the effectiveness of social service interventions. Clients will also frequently engage in behaviors that gratuitously seem to inhibit their progress and directly impede the attempts of the social worker to help get them back on track. Assess代写**成品

These situations, however, can provide an astute therapist with an opportunity to assess the aspects of the client’s cognition. And behavior that are holding them back and preventing them from improving their circumstances. The therapist can explore how the client’s actions fit into their broader behavioral patterns. And how they are symbolic of the client’s idiosyncratic thought patterns.

Meaningful working relations are a critical part of the relational theory of social work.  Assess代写

Relational theory recommends evidence-based practices that are rooted in the human necessity for authentic and fulfilling interactions. For this to occur in a therapy setting, the service provider must actively practice cultural competency. Cultural competency is not defined by systematic knowledge of a culture or rote memorization of a group’s customs. Rather, cultural competency refers to one’s ability to engage in self-reflective behavior that assesses one’s approach to handling clients with cultural backgrounds that likely differ from one’s own. Assess代写**成品

The development of a relational working model can help a social worker negotiate the distortions in the therapeutic process that are ongoing and co-created. Potential misunderstandings may arise from differences in gender, race, ethnicity, religion, sexual orientation, language, disability, and/or socioeconomic status (McKenzie, 2016).

Ms. F expresses frequent mistrust of the social service employees with whom she has interacted.  Assess代写

On several occasions, she has felt that CPS treated her unfairly and was not there to help her get better. To form a secure therapeutic alliance, I will need to demonstrate to Ms. F how I can help and that I am there specifically to help her. Fortunately, Ms. F recognizes that her drug-related activities are having a negative impact on her children’s affects and behaviors and she is willing to take the steps. That she deems necessary to regain their trust and affection. She also cherishes the smallest steps toward a more stable, healthy home life and acknowledges the assistance. That she has already been provided by social service workers prior to her enrollment with Archcare. Assess代写**成品

While she has obvious affection for her children, Ms. F frequently finds herself strained by the demands placed on her necessary to maintaining the household and would occasionally distance herself from her children. The periods would escalate her daughter’s defiant and demanding behavior. Which would in turn further increase the strain in the relationship between Ms. F and her children.

Through our early interactions and her descriptions of her anxieties, Ms. F revealed that she would rather avoid her problems than approach them head-on.  Assess代写

This has resulted in her unwillingness to answer several of my more probing questions and to redirect the conversation towards avenues that made her feel more comfortable. I would describe my first experience with Ms. F as informative and encouraging. I learned a lot about my own expectations of the therapeutic process and how I might need to account for Ms. F’s expectations. I will need to demonstrate to her that I am actively listening and critically thinking about the challenges she is describing to me. Assess代写**成品

Ms. F appeared during the encounter to be receptive to my assistance and mentioned twice that I reminded her of her younger sister. I will still need to work to ensure she feels safe when discussing her concerns with me since I do not want her to be holding back because of a perceived stigmatization. She made a comment about her lack of education in comparison to mine. And how she would try to make her language more “proper.” I did not know to respond.

Dialogue Results between Case Planner and Client  Assess代写

The following vignettes demonstrate dialogues where I used her resistance to further evaluate her struggles and where I made the mistake of talking about continuing her education.

Early in the session, Ms. F informed me that she began prostituting herself before she had turned 20 and that she still felt obligated to do so because it was her only tool to provide a stable income for herself and her children. Assess代写**成品

Client: *Leaning forward in her seat and rubbing her face. But I’m scared a lot. I worry I won’t come home for my girls and they won’t ever know what happened to me. They’ll end up thinking I just left them, and they already having a hard time.

Case Planner: Tell me about a time that made you feel that way.

Client: *Crosses her arms. There too many to talk about. I don’t really like thinking about them.

Case Planner: What would you tell your daughter if you knew she was engaging in prostitution?

Client: I couldn’t tell her nothing. I got no ground to stand on, cuz I made a lot of mistakes and I couldn’t be no example for her. But yeah I’d be scared for her. I’d want her to value herself more. She better than that. She gotta do better than me. I don’t want her to deal with the same shit that I’ve had to.

My goal in this first session was to prime Ms. F for the operalization of her situation and critical self-reflection regarding her personal narrative.  Assess代写

My questions were structured to work with her in parsing out the most significant moments in her life history and designed to push her toward a more critical reflection of their role in contributing to her current situation. My intention is to integrate this process with ecological and psychosocial models in an effort to address holistically the areas of stress in Ms. F’s life and to provide her with concrete methods for handling those stresses. This type of therapy utilizes the characteristics described in Gitterman & Heller (2011) which categorizes the benefits of a multi-discipline approach to developing a working alliance through motivational interviewing, cognitive-behavioral therapy, and a solution-focused practice.

The next exchange occurred during a discussion of Ms. F’s goals and expectations of her experience with Archcare.  Assess代写

She had previously expressed some regrets that she had dropped out of her classes at the community college and that she was unsure about what she might be able to do if she stopped working as a prostitute.

Case Planner: If you had the opportunity to return to school, what would you want to do?

Client: *Covers her eyes and crosses her legs. I don’t think I’d do it. It’s not worth failing again. I learned more through living than I ever learned at that place.

Case Planner: What are you hoping will change from these sessions?

Client: *Posture opens up, she seems caught off guard by the question but seems to be eager to answer. I want to be able to take care of myself so I can take care of my girls. I just want a happy and safe family.

Ms. F obviously recognizes that she operates in multiple roles and that most of her identities are malleable and have a special value.  Assess代写

Yan (2016) explains how social identities must be recognized and managed to ensure the recommended therapies are not normalizing social inequities. While her work as a prostitute is stigmatized by the mainstream culture, it has taught her valuable lessons about reading people’s body language and responding to potentially hazardous situations. Identifying these skills will help Ms. F to recognize her unique abilities and to be able to problem solve independently when attempting to use what she has learned to overcome new challenges.

Analysis  Assess代写

 I have learned so far that Ms. F has created schemas in which she classifies scenarios as stressful or easy.

She frequently avoids those situations where she doubts that she can be successful and prefers to accept tasks with which she has had a previous positive experience. As such, I must work to ensure she views my expectations as reasonable and easily implemented. Fortunately, she recognizes that she has the ability to transform her identities to better match the circumstances where she would prefer to see herself. By working with Ms. F to reduce the potential that she will feel overwhelmed and accounting for the impact of her various identities. Assess代写**成品

We can build a working alliance that allows Ms. F to derive a boost to her feelings of well-being stemming from the formation of a genuine therapeutic relationship. I hypothesize that Ms. F’s schemas have kept her from recognizing the potential benefits from her experiences. To test this hypothesis in future sessions, I will ask her more questions about times she did and did not act in a manner. That would assist her in achieving her personal goals and what she thinks she can do now to help her adjust those behaviors.

This assignment has taught me to value the mistakes I will make as a lifelong learner.  Assess代写

Because those are situations from which valuable lessons can be extracted and applied. I did well on this assignment because I appreciate the practice in recognizing my own strengths and limitations and how those parameters can best be utilized to help a client. I know that my ability to alter my questions to fit my clients’ responses will assist me in approaching novel challenges.  While my position as a more privileged individual than my clients will add an extra obstacle to the development of a working alliance. Assess代写**成品

I will continue to improve my execution of narrative exposure therapy to ensure that I am engaging in reflective questioning and continual self-evaluation. I should work to learn more about the ecological model so I can better recognize the social and environmental situations. That might be negatively impact a client’s life outcomes. My clinical skills could be improved by continual exposure to families in difficult situations and clients who are resistant to accepting my assistance.

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References   Assess代写

About Archcare. (2018). Retrieved from Archcare: The Continuing Care Community of the Archdiocese of New York: www.archcare.org

CF, N. (1994). Understanding Client Resistance: Methods for Enhancing Motivations to Change. Cognitive and Behavioral Practice, 1:47-69.

E., M. (1988). The First Session: An Interpersonal Encounter. Journal of Comtemporary Social Work, 23-27.

F, M. (2016). Cultural Competence, Biases, and Blind Spots. In Understanding and Managing the Therapeutic Relationship (pp. 45-53). New York: Oxford University Press.

Gitterman A, H. (2011). Integrating Social Work Perspectives and Models with Concepts, Methods, and Skills with Other Professions’ Specialized Approaches. Clinical Social Work, 204-211.

MC, Y. (2016). Multiple Personality and Intersectionality: Towards a Dialogical Social Work Approach. Diversity and Social Work in Canada, 38-114.

Suarez ZE, N. P. (2008). Critical Consiousness and Cross Cultural/ Intersectional Social Work Practice: A Case Analysis. Families in Society: The Journal of Comtemporary Social Services. doi:10.1606/1044-3894-3766

 

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