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12

 

Working With Families:

 

The Case of Carol and Joseph

 

Carol is a 23-year-old, heterosexual, Caucasian female and the

 

mother of a 1-year-old baby girl. She is currently unemployed,

 

having previously worked for a house cleaning company. The

 

baby is healthy and developmentally on target, and she and the

 

parents appear to be well bonded with one another. Carol lives in

 

a rented house with her husband, Joseph. Joseph is a 27-year-old,

 

heterosexual, Hispanic male. He was recently arrested at their

 

home for a drug deal, which he asserts was a setup. Both parents

 

were charged with child endangerment because weapons were

 

found in the child’s crib and drugs were found in the home. The

 

parents assert that the child never sleeps in the crib but in their

 

bed. As a result of the parents’ arrest, social services was notified,

 

and the child was temporarily placed in a kinship care arrangement

 

with the maternal grandmother, who resides nearby. As a

 

result of Joseph’s arrest, he was fired from the cleaning company

 

where he worked, and the family is now experiencing financial

 

difficulties.

 

After initial contact was made with the parents, a number of

 

concerns were noted and the family was recommended for additional

 

case management. Carol’s mother indicated that she had

 

concerns about Carol’s drinking habits and stated that Carol’s

 

father and grandfather were alcoholics. She and the father separated

 

when Carol was a baby, and Carol has had only limited

 

contact with him. There appears to be significant tension between

 

the grandmother and Carol and Joseph. I addressed the alcohol

 

issue with both parents, who denied there was a problem, but

 

shortly after the discussion, Carol was involved in a serious car

 

accident with the baby in the car. She was determined to have been

 

under the influence of alcohol. I advised Carol that she could not

 

have any unsupervised contact with her child until she completed

 

intensive inpatient substance abuse treatment. I made arrangements

 

for her placement, but after a week, she was discharged

 

for noncompliance with the rules. She was then referred to an

 

intensive outpatient program and began therapy there. Initially

 

 

 

her attendance was erratic because she had lost her license as a

 

result of the DUI. Eventually, however, she became engaged in the

 

program and began to address her issues. She acknowledged that

 

she had started using drugs at a very young age but said that she

 

had only begun drinking in the previous year or so. We discussed

 

the genetics of her family, and she said that she realized that she

 

had deteriorated rapidly since beginning to drink and knew that

 

she simply could not drink alcohol.

 

Joseph’s mother is deceased, and his father travels extensively

 

in his job and is not available as a support. Joseph was

 

very devoted to his mother and was devastated by her premature

 

death. We discussed the strengths that he and Carol demonstrated

 

in staying together and working out their problems. Joseph indicated

 

that as a Hispanic man, family is very important to him and

 

he wants his family to stay together. Although they have been

 

struggling financially, Joseph has obtained stable employment

 

landscaping for a large development and said he plans to take

 

courses at the community college to learn the trade. He stated

 

that he wants to provide a good life for his child. Carol has a lot of

 

unresolved issues to deal with in therapy, not the least of which is

 

the accident that could have killed her child and the legal ramifications

 

that resulted from this incident. Although angry and hostile

 

at the beginning, through the implementation of person-centered

 

therapy, we were able to establish agreed-upon goals that showed

 

respect for the client and encouraged her to find solutions to

 

her problems. Although our relationship was tenuous at times,

 

providing encouragement to her rather than judgment enabled

 

her to forgive herself and take corrective action.

 

 

 

Reflection questions

 

 

 

the common myth that a traditional therapy office setting is

 

necessary to do “clinical work.”

 

Through this case, students can also witness how treatment

 

goals can shift throughout the course of treatment.

 

This is evident in the step-by-step growth that Pedro demonstrated.

 

Each shift in treatment goals resulted in a change or

 

deepening of our relationship and gave Pedro the opportunity

 

to address more difficult issues as time went on.

 

Working With Families: The Case of Carol and Joseph

 

1. What specific intervention strategies (skills, knowledge,

 

etc.) did you use to address this client situation?

 

This case required extensive use of active and passive listening

 

and patience to enable the client to become sufficiently comfortable

 

with me and to arrive at a point where she could work on

 

her issues. Initially she was very angry, hostile, resistant, and

 

very much in denial.

 

2. Which theory or theories did you use to guide your practice?

 

I work with people in their homes, which is their territory, not

 

mine. I think it is very important to be aware of how I would feel

 

if I were in their shoes. The person-in-environment perspective

 

and Carl Rogers’ person-centered approach are crucial here.

 

3. What were the identified strengths of the client(s)?

 

She was smart and had a good support system in her husband

 

and mother, who were very supportive during her treatment.

 

4. What were the identified challenges faced by the client(s)?

 

Carol was a severe alcoholic and had a drug problem to a lesser

 

extent. She had psychological issues as well, including low selfesteem,

 

depression, and anxiety. She also had transportation and

 

legal problems as a result of losing her driver’s license after the DUI.

 

5. What were the agreed-upon goals to be met to address the

 

concern?

 

The primary goal was to protect her child by keeping Carol

 

sober and finding the intervention method that would be most

 

appropriate for her to do that. This took time due to the resistance

 

6. How would you advocate for social change to positively

 

affect this case?

 

Treatment options and access to them need to be improved

 

in rural areas. There were not many choices for this client,

 

and losing her license in an area with no public transportation

 

greatly affected her ability to seek treatment.

 

7. Is there any additional information that is important to this

 

case?

 

I subsequently found out that there had been other serious

 

episodes concerning Carol’s drinking that the family had failed

 

to disclose to me because they were covering up for her.

 

Carol’s parents separated when she was very young, so she

 

was mostly cared for by a family friend and grandparents. Carol’s

 

mother seemed to have resented the child’s interference with her

 

social life, and clearly the daughter resented her mother’s lack of

 

involvement with her. Carol’s mother, who was from a Southern

 

White Protestant family, seemed uncomfortable with Joseph’s

 

culturally unfamiliar Hispanic Catholic background. She reported

 

to me that she felt the son-in-law was lazy and did not work in the

 

early stages of his relationship with her daughter, who she said

 

worked very hard. During my involvement with this couple, I found

 

Joseph to be hard working and doing his best to provide for all of

 

them. He was very committed to doing whatever was necessary

 

to keep his family intact, even if his judgment at times was poor.

 

Working With Immigrants and Refugees:

 

The Case of Aaron

 

1. What specific intervention strategies (skills, knowledge,

 

etc.) did you use to address this client situation?

 

I used support, active listening, reflection, reframing, and validation

 

with the client, and I recognized the importance of

 

structure, reliability, and predictability of the social worker in

 

the therapeutic alliance.

 

2. Which theory or theories did you use to guide your practice?

 

I used family systems theory, multicultural family theories, and

 

attachment theory.to treatment.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Working With Survivors of Domestic Violence: The Case of Charo

 

Charo is a 34-year-old, heterosexual, Hispanic female. She is unemployed and currently lives in an apartment with her five chil­dren, ages 2, 3, 6, 7, and 8. She came to this country 8 years ago from Mexico with her husband, Paulo. During intake, Charo reported that she suffered severe abuse and neglect in the home as a child and rape as a young adult. Charo does not speak English and currently does not have a visa to work.

 

Charo initially came for services at our domestic violence agency because Child Protective Services (CPS) and the court ordered her to attend a domestic violence support group after allegations of domestic violence were made by one of her chil­dren to a teacher at their school. Her husband was ordered to attend a batterer’s intervention program (BIP). Charo attended the domestic violence support group but seldom said a word. Although she rarely shared during group, she also rarely missed a session. While she attended the group, she also met with me weekly for individual sessions. During these sessions I informed her of the dynamics of domestic violence and helped her create a safety plan. She often said that she was only attending the group because it was mandated and that she just wanted CPS to close her case. One week, Charo suddenly stopped attending group. When I called her, she said that she had been busy and unable to attend. That same day her husband called me to verify that I was who his wife said I was, as he often accused Charo of having affairs.

 

Charo showed up to group again one day after a 3-month absence. Her appearance was disheveled, and she had lost a significant amount of weight. The next day she called me and requested an emergency individual session. During the session, she reported that her husband had an imaginary friend who was telling him to kill her and that the previous weekend he had placed a knife on her pillow and threatened to take her life. Charo stated that her husband would force her to wear short skirts and bleach

 

 

 

her hair. He would also throw plates of food on the floor and walls of the house whenever meals were not to his satisfaction. She said he would spend his days drinking alcohol with friends and would beat her relentlessly in front of the children. She told me she had thought he would change after CPS became involved but that, instead, his abuse became more calculating and discreet.

 

I worked on an updated safety plan with the client, and she agreed to hide herself and the children in the agency’s safe house. The safety plan included information on obtaining a restraining order, going into a safe house, identifying safe people she could talk to, and teaching the children safety planning strategies as well as tips on important documentation and the importance of journ­aling all significant details of the abuse. Charo’s husband showed up outside of the agency that day while she was there and called her phone repeatedly. Charo put the call on speaker so I could hear his voice. He ordered her to go outside and go home with him and made threats toward her. I called the police, and Charo’s husband was arrested outside of the agency. I went to the court­house with Charo, helping her file a temporary restraining order and providing her with emotional support throughout the experi­ence. After obtaining the restraining order, Charo and her five children were admitted to the agency’s safe house.

 

While at the safe house, Charo met with me weekly for indi­vidual counseling and continued to attend the domestic violence support groups. She reported feeling damaged, ugly, and unlov­able. She also reported feeling anxious, depressed, and hopeless, crying often, and losing weight. Charo’s husband was eventually deported back to Mexico.

 

I discussed with Charo the dynamics of domestic violence and provided her with numerous resources that could serve as informal and formal supports to her and the children. Charo was referred to a psychiatrist, who prescribed 50 mg of Zoloft to help manage the anxiety and depressive symptoms she was experiencing. Charo began attending a church nearby where she quickly felt connected and also began attending English as a second language (ESL) classes twice a week. We met once a week for 9 months. During the first 3 months, we focused on stabilization. During the second 3 months, we focused on decreasing symptoms of anxiety

 

 

 

and depression. During the final 3 months of our time together

 

we focused on financial empowerment, reintegrating back into the

 

community, and renewing connections with family.

 

While Charo met with me for counseling and case management,

 

her children participated in a 6-month trauma reduction art

 

therapy program for children within the agency. At the 9-month

 

mark, we agreed to terminate services. She continued to attend

 

the group sessions for support and found new friends who had

 

become a support network for her. She also completed a financial

 

empowerment program, which further taught her how to manage

 

her finances.

 

 

 

Reflection Questions

 

. How would you advocate for social change to positively

 

affect this case?

 

Mary and her family could benefit from help exploring their

 

assumptions about race, but this was out of the scope of

 

Mary’s initial therapy.

 

8. Were there any legal or ethical issues present in the case?

 

If so, what were they and how were they addressed?

 

It is difficult but important to respect Mary’s therapeutic

 

process while remaining nonjudgmental about the assumptions

 

about race Mary and her sisters hold as truth.

 

9. How can evidence-based practice be integrated into this

 

situation?

 

Mary and I identified her PTSD symptoms in her treatment

 

plan. We were able to measure the successes she had with

 

specific behavioral interventions in changing the frequency

 

and severity of her symptoms.

 

10. Describe any additional personal reflections about this case.

 

Mary clearly felt that she needed to trust that I would not bring

 

my own judgments or opinions about racism into therapy.

 

As with all trauma treatment, building a therapeutic alliance

 

and trust was essential. We built such an alliance so she could

 

feel safe enough to tell her traumatic story and work to assimilate

 

that story into her own sense of strength and resilience.

 

Working With Survivors of Domestic Violence:

 

The Case of Charo

 

1. What specific intervention strategies (skills, knowledge,

 

etc.) did you use to address this client situation?

 

I utilized psychoeducational support groups, case management,

 

and solution-focused interventions.

 

2. Which theory or theories did you use to guide your practice?

 

I used learning theory and feminist empowerment and strengthsbased

 

perspectives to guide my practice.

 

3. What were the identified strengths of the client(s)?

 

Charo’s many strengths included her level of resilience and

 

being a strong advocate for her children and a support to

 

other survivors at the shelter. She also shared her resources

 

with other survivors no matter how little she had. She was

 

very kind.

 

4. What were the identified challenges faced by the client(s)?

 

The barriers for this client are enormous; aside from the

 

domestic violence, some of the barriers include not speaking

 

English, the involvement of Child Protective Services, a lack

 

of affordable housing, obtaining employment without a visa,

 

discrimination, and needing child care for five children.

 

5. What were the agreed-upon goals to be met to address the

 

concern?

 

The three treatment goals we set were reducing depressive and

 

anxiety symptoms, connecting to resources in the community

 

that would help her become more stable, and obtaining therapy

 

for the children.

 

6. What local, state, or federal policies could (or did) affect

 

this situation?

 

The Violence Against Women Act (VAWA) affected the

 

situation.

 

7. How would you advocate for social change to positively

 

affect this case?

 

Victims should not be mandated to attend a domestic violence

 

support group. Participation should be voluntary. These women

 

have been coerced in their relationships and then they are

 

coerced by the system and made to feel like they have done

 

something wrong. Much more education is needed in the courts

 

and with Child Protective Services.

 

8. How can evidence-based practice be integrated into this

 

situation?

 

Clients are asked to complete client satisfaction surveys at

 

termination. We also call the clients for follow-ups for up to

 

a year. Lastly, clients complete a survey on a monthly basis,

 

which is used statewide and called the Family Violence Prevention

 

and Services Act (FVPSA) survey. The surveys mainly

 

measure whether the client learned additional resources and

 

additional ways of planning for safety.

 

 

 

 

 

Working With Survivors of

 

Sexual Abuse and Trauma:

 

The Case of Angela

 

Angela is a 27-year-old, Caucasian female, who first came to

 

counseling to address her history of sexual abuse. She graduated

 

from college with a BS in chemistry and has since been employed

 

by pharmaceutical companies. After obtaining a new job, she relocated

 

to an apartment in an East Coast city where she knew no

 

one. Both of Angela’s parents live on the West Coast, and she has

 

one younger brother who also lives in a different state. Angela has

 

limited contact with both her mother and brother and does not

 

have any contact with her father. Angela is obese and disclosed

 

a history of struggling with her weight and eating issues. She has

 

few friends, and those she does have live far away.

 

Angela has a long history of trauma in her life. She was sexually

 

abused between the ages of 9 and 21 by her father, sexually assaulted

 

at the age of 14 by a classmate in school, and mugged as a young

 

adult. There was domestic violence in the home, also perpetrated by

 

her father. Angela’s father is considered an upstanding member of

 

the community, and he is well liked and respected by others. No one

 

in Angela’s family believes that she was sexually abused, and her

 

father joined a “false memory syndrome” group and is outspoken

 

about that issue. There has been little discussion in her family about

 

what took place in the home while she was growing up.

 

Angela struggled with daily functioning and exhibited symptoms

 

of post-traumatic stress disorder (PTSD). She had a history

 

of cutting herself and binge eating and displayed some characteristics

 

of borderline personality disorder. Angela also mildly

 

dissociated when under duress. Angela suffered from depression

 

and anxiety and had trouble establishing new relationships, both

 

socially and at work. Although Angela has a stable job and was

 

able to complete her work each day, at times she became overwhelmed

 

by her emotions and retreated to the bathroom where

 

she cried and sometimes cut herself before returning to her workstation.

 

Angela relied on writing, artwork, and her cat for solace

 

and comfort. She was also very active outdoors, often hiking,

 

biking, and going on camping trips by herself. Her goals in life

 

were to own her own home, lose weight, enjoy relationships with

 

others, and find peace with her traumas.

 

As a result of the abuse she experienced, it was necessary to

 

begin treatment focusing heavily on establishing trust and a relationship

 

with the client. After 1 year of therapy, deeper process

 

work was being done around her traumas, and she was able to

 

open up much more. She disclosed more painful experiences to

 

the therapist and began expressing her feelings, including intense

 

anger at her family members.

 

Angela also joined a group for survivors of sexual violence in

 

the same program where she was receiving individual therapy.

 

She was thus able to meet other survivors and engage them in

 

relationship building and obtain support. Over time, she lost

 

100 pounds and made new friends, and her level of functioning

 

increased dramatically. Six months into the group, however, I

 

noticed boundary issues between the members of the group and

 

the group facilitator. After speaking with the group facilitator

 

about these concerns and others regarding her clinical judgment

 

and boundary crossing, the decision was made to terminate her.

 

As a new group facilitator began engaging the group, I noticed

 

that Angela was not sharing as much in her individual sessions

 

and, overall, seemed guarded. I tried on numerous occasions to

 

address the shift, and while Angela acknowledged that trust had

 

become an issue, she would not directly express her concerns or

 

feelings. After some discussion, I explained to Angela that while I

 

could not discuss the issues concerning the group facilitator, she

 

should feel free to talk about her feelings and concerns in general.

 

However, it became obvious that trust could not be rebuilt, particularly

 

in light of the professional boundary issues with the group

 

facilitator. I asked if she wanted to terminate counseling with me

 

and find a new therapist, and Angela agreed. I provided Angela

 

with three referrals so that she could continue her treatment. I

 

learned that Angela and the former group facilitator had become

 

friends and remained so after both had left the program in their

 

respective capacities.

 

Reflection Questions

 

activities as Veronica did. She went to school every day and did

 

not appear very different from other children in her area. It is

 

important to note that families in poverty-stricken countries like

 

Guatemala are deceived by traffickers who offer them money

 

equivalent to a year’s income in exchange for their children. All

 

the details of this case are not clear as of yet but it is believed that

 

the maternal aunt was working in conjunction with someone else.

 

9. Describe any additional personal reflections about this case.

 

This was a hard case to digest. It is one of those cases that you

 

end up taking home with you in your heart. This 13-year-old

 

girl has been through a lifetime of exploitation. For the first few

 

weeks she would just look at me as if she were looking right

 

through me. She needed a lot of coaxing to participate. Although

 

she still has a great deal of healing ahead of her, Veronica is in a

 

much better place and is making every effort to live a normal life.

 

Working With Survivors of Sexual Abuse and Trauma:

 

The Case of Angela

 

1. What specific intervention strategies (skills, knowledge,

 

etc.) did you use to address this client situation?

 

Knowledge of trauma and child sexual abuse was key as was

 

active listening, validation, boundary setting, and, at times,

 

confrontation.

 

2. Which theory or theories did you use to guide your practice?

 

I applied relational, cognitive behavioral, empowerment, and

 

strengths-based theories.

 

3. What were the identified strengths of the client(s)?

 

Angela’s strengths were her ability to persevere and be resilient,

 

as well as her ability to find time for self-reflection and

 

self-care. Despite everyone around her telling her otherwise,

 

she was still able to stand firm in the knowledge that she was

 

sexually abused and therefore needed to have clear boundaries

 

with those who did not believe her.

 

4. What were the identified challenges faced by the client(s)?

 

Angela’s challenges included an occasional inability to function

 

at work, self-harm, and isolation.

 

 

 

5. What were the agreed-upon goals to be met to address

 

the concern?

 

The goals were to increase functioning, enhance ability to

 

create and sustain relationships with others, reduce isolation,

 

address and increase self-esteem, refrain from cutting, and

 

work through early sexual trauma.

 

6. What local, state, or federal policies could (or did) affect

 

this situation?

 

The statute of limitations in both civil and criminal cases

 

affected Angela’s case.

 

7. How would you advocate for social change to positively

 

affect this case?

 

I would advocate with legislators in the state to eliminate the

 

statute of limitations so that survivors of sexual abuse could

 

prosecute and/or sue their perpetrator when they were ready.

 

8. Were there any legal or ethical issues present in the case?

 

If so, what were they and how were they addressed?

 

There were ethical issues regarding boundaries and dual

 

relationships. The group facilitator in this case was inappropriate

 

with her clients and became personal friends with this

 

particular client along with the other women in the group. I

 

addressed this by trying to work with the group facilitator, as

 

well as by encouraging her to discuss this in her off-site clinical

 

supervision. Because no change was occurring, eventually

 

the group facilitator was terminated.

 

9. How can evidence-based practice be integrated into this

 

situation?

 

The use of a sequenced, titrated approach using relational

 

theory to address complex PTSD is incredibly helpful, especially

 

for those survivors of sexual trauma with multiple

 

victimizations and difficulty with daily functioning.

 

10. Describe any additional personal reflections about this case.

 

As the individual therapist, this case was heartbreaking for

 

me. The relationship and trust I had built with this client was

 

destroyed, and I was placed in a very precarious position. The

 

client did not want to discuss the changing dynamic andclearly been influenced by the group facilitator, who was incredibly

 

friendly and outgoing. There was no other choice but termination,

 

and the realization that the damage could not be repaired was

 

disappointing. However, had I disclosed “my side” of what was

 

happening, I would have been making the same errors as the group

 

facilitator and involving myself in a dysfunctional and unhealthy

 

dynamic, including crossing boundaries—exactly what survivors

 

do not need. There are times when you must “swallow your pride”

 

to do what is right and best for the client, especially given the

 

different variables and considering the ethical issues at play.

 

Working With Survivors of Sexual Abuse and Trauma:

 

The Case of Brenna

 

1. What specific intervention strategies (skills, knowledge,

 

etc.) did you use to address this client situation?

 

I used reflective listening and reframing to assist Brenna in

 

setting goals and determining her unmet needs. I used knowledge

 

of local systems and social service agencies to provide

 

referrals and to secure needed services.

 

2. Which theory or theories did you use to guide your practice?

 

I utilized systems theory.

 

3. What were the identified strengths of the client(s)?

 

Brenna’s strengths were her resiliency and self-sufficiency.

 

Brenna viewed her desire to provide a better future for her

 

child as a strong motivating factor for changing her life.

 

4. What were the identified challenges faced by the client(s)?

 

Brenna lacked a familial support system and network of friends,

 

and she was socially isolated. Upon entry to the shelter, she lacked

 

medical care, employment, income, and housing. Brenna also struggled

 

with difficulty reading and writing. Brenna had experienced

 

trauma and violence in her past and would be raising her child alone.

 

5. What were the agreed-upon goals to be met to address the

 

concern?

 

Brenna and I agreed to secure medical care, a housing plan,

 

and a source of income. Brenna also set goals to improve her

 

mental health.

 

 

 

 

 

Working With Survivors of

 

Sexual Abuse and Trauma:

 

The Case of Angela

 

Angela is a 27-year-old, Caucasian female, who first came to

 

counseling to address her history of sexual abuse. She graduated

 

from college with a BS in chemistry and has since been employed

 

by pharmaceutical companies. After obtaining a new job, she relocated

 

to an apartment in an East Coast city where she knew no

 

one. Both of Angela’s parents live on the West Coast, and she has

 

one younger brother who also lives in a different state. Angela has

 

limited contact with both her mother and brother and does not

 

have any contact with her father. Angela is obese and disclosed

 

a history of struggling with her weight and eating issues. She has

 

few friends, and those she does have live far away.

 

Angela has a long history of trauma in her life. She was sexually

 

abused between the ages of 9 and 21 by her father, sexually assaulted

 

at the age of 14 by a classmate in school, and mugged as a young

 

adult. There was domestic violence in the home, also perpetrated by

 

her father. Angela’s father is considered an upstanding member of

 

the community, and he is well liked and respected by others. No one

 

in Angela’s family believes that she was sexually abused, and her

 

father joined a “false memory syndrome” group and is outspoken

 

about that issue. There has been little discussion in her family about

 

what took place in the home while she was growing up.

 

Angela struggled with daily functioning and exhibited symptoms

 

of post-traumatic stress disorder (PTSD). She had a history

 

of cutting herself and binge eating and displayed some characteristics

 

of borderline personality disorder. Angela also mildly

 

dissociated when under duress. Angela suffered from depression

 

and anxiety and had trouble establishing new relationships, both

 

socially and at work. Although Angela has a stable job and was

 

able to complete her work each day, at times she became overwhelmed

 

by her emotions and retreated to the bathroom where

 

she cried and sometimes cut herself before returning to her workstation.

 

Angela relied on writing, artwork, and her cat for solace

 

SOCIAL WORK CASE STUDIES: FOUNDATION YEAR

 

30

 

and comfort. She was also very active outdoors, often hiking,

 

biking, and going on camping trips by herself. Her goals in life

 

were to own her own home, lose weight, enjoy relationships with

 

others, and find peace with her traumas.

 

As a result of the abuse she experienced, it was necessary to

 

begin treatment focusing heavily on establishing trust and a relationship

 

with the client. After 1 year of therapy, deeper process

 

work was being done around her traumas, and she was able to

 

open up much more. She disclosed more painful experiences to

 

the therapist and began expressing her feelings, including intense

 

anger at her family members.

 

Angela also joined a group for survivors of sexual violence in

 

the same program where she was receiving individual therapy.

 

She was thus able to meet other survivors and engage them in

 

relationship building and obtain support. Over time, she lost

 

100 pounds and made new friends, and her level of functioning

 

increased dramatically. Six months into the group, however, I

 

noticed boundary issues between the members of the group and

 

the group facilitator. After speaking with the group facilitator

 

about these concerns and others regarding her clinical judgment

 

and boundary crossing, the decision was made to terminate her.

 

As a new group facilitator began engaging the group, I noticed

 

that Angela was not sharing as much in her individual sessions

 

and, overall, seemed guarded. I tried on numerous occasions to

 

address the shift, and while Angela acknowledged that trust had

 

become an issue, she would not directly express her concerns or

 

feelings. After some discussion, I explained to Angela that while I

 

could not discuss the issues concerning the group facilitator, she

 

should feel free to talk about her feelings and concerns in general.

 

However, it became obvious that trust could not be rebuilt, particularly

 

in light of the professional boundary issues with the group

 

facilitator. I asked if she wanted to terminate counseling with me

 

and find a new therapist, and Angela agreed. I provided Angela

 

with three referrals so that she could continue her treatment. I

 

learned that Angela and the former group facilitator had become

 

friends and remained so after both had left the program in their

 

respective capacities.

 

activities as Veronica did. She went to school every day and did

 

not appear very different from other children in her area. It is

 

important to note that families in poverty-stricken countries like

 

Guatemala are deceived by traffickers who offer them money

 

equivalent to a year’s income in exchange for their children. All

 

the details of this case are not clear as of yet but it is believed that

 

the maternal aunt was working in conjunction with someone else.

 

9. Describe any additional personal reflections about this case.

 

This was a hard case to digest. It is one of those cases that you

 

end up taking home with you in your heart. This 13-year-old

 

girl has been through a lifetime of exploitation. For the first few

 

weeks she would just look at me as if she were looking right

 

through me. She needed a lot of coaxing to participate. Although

 

she still has a great deal of healing ahead of her, Veronica is in a

 

much better place and is making every effort to live a normal life.

 

Working With Survivors of Sexual Abuse and Trauma:

 

The Case of Angela

 

1. What specific intervention strategies (skills, knowledge,

 

etc.) did you use to address this client situation?

 

Knowledge of trauma and child sexual abuse was key as was

 

active listening, validation, boundary setting, and, at times,

 

confrontation.

 

2. Which theory or theories did you use to guide your practice?

 

I applied relational, cognitive behavioral, empowerment, and

 

strengths-based theories.

 

3. What were the identified strengths of the client(s)?

 

Angela’s strengths were her ability to persevere and be resilient,

 

as well as her ability to find time for self-reflection and

 

self-care. Despite everyone around her telling her otherwise,

 

she was still able to stand firm in the knowledge that she was

 

sexually abused and therefore needed to have clear boundaries

 

with those who did not believe her.

 

4. What were the identified challenges faced by the client(s)?

 

Angela’s challenges included an occasional inability to function

 

at work, self-harm, and isolation.

 

 

 

5. What were the agreed-upon goals to be met to address

 

the concern?

 

The goals were to increase functioning, enhance ability to

 

create and sustain relationships with others, reduce isolation,

 

address and increase self-esteem, refrain from cutting, and

 

work through early sexual trauma.

 

6. What local, state, or federal policies could (or did) affect

 

this situation?

 

The statute of limitations in both civil and criminal cases

 

affected Angela’s case.

 

7. How would you advocate for social change to positively

 

affect this case?

 

I would advocate with legislators in the state to eliminate the

 

statute of limitations so that survivors of sexual abuse could

 

prosecute and/or sue their perpetrator when they were ready.

 

8. Were there any legal or ethical issues present in the case?

 

If so, what were they and how were they addressed?

 

There were ethical issues regarding boundaries and dual

 

relationships. The group facilitator in this case was inappropriate

 

with her clients and became personal friends with this

 

particular client along with the other women in the group. I

 

addressed this by trying to work with the group facilitator, as

 

well as by encouraging her to discuss this in her off-site clinical

 

supervision. Because no change was occurring, eventually

 

the group facilitator was terminated.

 

9. How can evidence-based practice be integrated into this

 

situation?

 

The use of a sequenced, titrated approach using relational

 

theory to address complex PTSD is incredibly helpful, especially

 

for those survivors of sexual trauma with multiple

 

victimizations and difficulty with daily functioning.

 

10. Describe any additional personal reflections about this case.

 

As the individual therapist, this case was heartbreaking for

 

me. The relationship and trust I had built with this client was

 

destroyed, and I was placed in a very precarious position. The

 

client did not want to discuss the changing dynamic and had

 

clearly been influenced by the group facilitator, who was incredibly

 

friendly and outgoing. There was no other choice but termination,

 

and the realization that the damage could not be repaired was

 

disappointing. However, had I disclosed “my side” of what was

 

happening, I would have been making the same errors as the group

 

facilitator and involving myself in a dysfunctional and unhealthy

 

dynamic, including crossing boundaries—exactly what survivors

 

do not need. There are times when you must “swallow your pride”

 

to do what is right and best for the client, especially given the

 

different variables and considering the ethical issues at play.

 

Working With Survivors of Sexual Abuse and Trauma:

 

The Case of Brenna

 

1. What specific intervention strategies (skills, knowledge,

 

etc.) did you use to address this client situation?

 

I used reflective listening and reframing to assist Brenna in

 

setting goals and determining her unmet needs. I used knowledge

 

of local systems and social service agencies to provide

 

referrals and to secure needed services.

 

2. Which theory or theories did you use to guide your practice?

 

I utilized systems theory.

 

3. What were the identified strengths of the client(s)?

 

Brenna’s strengths were her resiliency and self-sufficiency.

 

Brenna viewed her desire to provide a better future for her

 

child as a strong motivating factor for changing her life.

 

4. What were the identified challenges faced by the client(s)?

 

Brenna lacked a familial support system and network of friends,

 

and she was socially isolated. Upon entry to the shelter, she lacked

 

medical care, employment, income, and housing. Brenna also struggled

 

with difficulty reading and writing. Brenna had experienced

 

trauma and violence in her past and would be raising her child alone.

 

5. What were the agreed-upon goals to be met to address the

 

concern?

 

Brenna and I agreed to secure medical care, a housing plan,

 

and a source of income. Brenna also set goals to improve her

 

mental

 

6. What local, state, or federal policies could (or did) affect

 

this situation?

 

State policies regarding photo ID affected Brenna’s ability to

 

apply for various assistance programs through Social Services.

 

Temporary Assistance for Needy Families (TANF) policies will

 

also affect her ability to obtain financial assistance after giving

 

birth. Paternity is required on forms for TANF, and she may

 

need to explore domestic violence waivers when completing

 

TANF applications.

 

7. How would you advocate for social change to positively

 

affect this case?

 

I would advocate for improved assistance to be offered through

 

Social Services. Brenna was often met with anger and frustration

 

at Social Services due to her difficulty reading and writing,

 

so she had given up on trying to secure medical care and financial

 

assistance early in her pregnancy.

 

8. Were there any legal or ethical issues present in the case?

 

If so, what were they and how were they addressed?

 

Brenna and I discussed future plans for applying for TANF and

 

the impact the child’s paternity has on approval of the application.

 

We discussed the parental rights of Cameron and identified

 

resources for legal assistance if needed in the future.

 

9. Describe any additional personal reflections about this case.

 

When working on a strict timeline, it is important to balance

 

client empowerment with health and safety.

 

Human Behavior and the Social Environment

 

Working With Children and Adolescents:

 

The Case of Dalia

 

1. What specific intervention strategies (skills, knowledge,

 

etc.) did you use to address this client situation?

 

This case required that active and reflective listening, reframing,

 

and validation be employed as part of the assessment, engagement,

 

and goal-setting process. In addition, working from the

 

strengths-based perspective and meeting the client system

 

 

 

 

 

 

 

 

 

  • Project: Agency Visit

    In order to function as change agents, social workers interact with others in a wide variety of organizations. Visiting a social work agency allows students of social work to get a glimpse of the form that these interactions may take.

    For this Assignment, visit a nonprofit social service agency in your area and interview a social worker there.

    By Day 7 of this week, you identify your agency and the social worker you will collaborate with. Your Final Project, submitted in Week 10 of the course, should focus on the following.

    During the interview:

 

1.     Focus on the social worker’s educational background and training.

 

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