Tuesday, June 4, 2019
Clients Description And Functioning Social Work Essay
nodes Description And Functioning amicable Work EssayThe customer is a sixteen-year- oldish Afri crumb Ameri groundwork female who is heavy(predicate) with her imprimatur child. The knob attends junior high shallow. The invitee lives with her mother, age unknown, who is unemployed.B. SettingPeak View behavioural Health is located in Colorado Springs, Colorado. Peak View behavioural Health is a psychiatric hospital dedicated to providing quality c ar to promote growth and structure for guests and families (Peak View Behavioral Health, 2012). Peak View Behavioral Health treats adults ages eighteen and older and, in January 2013, result begin to serve children ages four to seventeen. The hospitals services include acute psychiatric care, partial hospitalization, intensive outpatient services, burden misuse, twenty-four hour assessment and Electroconvulsive Therapy.C. Reason for ReferralThe guest was referred to Each One Teach One, an alternative school, by her prior public sc hool principal. The node is gravid with her second child and has been suspended from the public school. Adolescent maternal quality, intended or non, suffer have nix consequences. Common consequences of adolescent pregnancy include dropping out of high school, living in poorness, relying on public welfare, and experiencing higher levels of psychological distress, as compared to their same age peers (Stoiber, 2005). The consequences of the clients pregnancies are reflected by her situation. She has been referred to an alternative school and experiences psychological stress which impacts her races. The principal was certain of the clients beginning(a) pregnancy, although no previous interventions were attempted. The principal suspects the client is having difficulty in her nursing home life, although she will non damp to the principal how she became pregnant twice. leaf node is not happy about the suspension from public school. lymph node does not understand why she is be ing suspended because she touchs as though she has not done whateverthing wrong. Although she is upset about the suspension from her public school, she does seem interested in the referral to the alternative school as evidence by her accepting the referral and attending Each One Teach One. One of the highlighted strengths in the lives of Afri cease Americans is their strong educational or achievement orientation (Boyd-Franklin, 2006). Although the client is experiencing a negative companionable and economic purlieu, she appears to be motivated to better herself. The clients mother does not fight back the referral for client to attend the alternative school. The clients mother encourages the client not to attend school and get on the Welfare.D. Clients Description and FunctioningClient is of average height and pregnant. Client attends school well groomed, e.g, hair brushed, teeth brushed, showered, and wears clothing that are clean and well-fitted. Although the client is pregn ant, she is able to walk to school and walk up and down the stairs to her apartment without difficulty. Client took necessary testing precautions to be tested for Human Immunodeficiency Virus (HIV) after learning her father passed away from Acquired Immunodeficiency Syndrome (AIDS). Consequently, client tested positive for Human Immunodeficiency Virus (HIV).Client does not declaim grammatically correct English as evidenced by client stating sentences such as I is learning, I does my work, and what this one is? Although client reports she sits in the bear out of the classroom, does not open a book and does not participate, clients math teacher reports client does well in math. Client has difficulty reading. The clients mother reports client as stupid and not ever amounting to anything. Client identifies one of her strengths as cooking. Client reports auditory and visual hallucinations in the form of vampires telling her you are one of us. Client fantasizes about being white, living rich and famous, and being saved from her current situation.E. Physical and Economic EnvironmentThe clients mother is unemployed and receives welfare of an unknown periodic amount. Clients mother has custody of clients first child in order to receive aide on that child. Client attended public school until suspended and will be attending Each One Teach One. In the evenings, client cooks and cleans for the household. Client describes her mothers day as a beached whale lying on the couch. Client states her mother eats, watch T.V., eats, watch T.V.The client and mother live in a two bedroom apartment, rent unknown, in Harlem. Client describes the part as the ghetto and consumed with crack heads. The clients apartment building is sprayed with graffiti. Americans visualize the ghetto as w here the black people live re positioning a deplorable, susceptible to crime, drug-infected and violent part of the city (Anderson, 2012). The client defines her neighborhood as the ghetto receivabl e to drug activity and crime.F. Current Social Functioning1. Family Situation. The client and mother live in apartment together. The clients mother has custody of the clients first born child and claims that child for welfare purposes, although the child actually lives with clients grandmother. The clients father previously lived in the home with client and mother prior to moving out. Clients relationship with her mother is volatile. The clients mother reported she should have aborted her. Client cooks for her mother, cleans the home, and runs errands for her mother when needed. Client fantasizes of wanting to be on the cover of a magazine or in a music video.Client has current and past archives of sexual and material abuse. Client was raped by her father. The clients first child, and the second child she is pregnant with, are products of rape by the clients father. The clients mother is aware of the rape of the client by her father simply blames the client for taking my man. The clients mother overly blames the client for clients father moving out of the house. The clients mother in like manner admitted to sexually abusing client, stating who was going to please me. Client has also experienced physical abuse at the pass of her mother. The clients mother has slapped her and thrown a frying pan towards her head. The clients mother is verbally abusive calling client names such as bitch, whore, good for cypher and stupid.2. Current Sexual/Emotional Relationship. Client reports never having a boyfriend but wishes she had a light skin boyfriend with nice hair.3. Occupational/ school day Situation. Client has been suspended from public school and referred to Each One Teach One, an alternative school, due to her second pregnancy. Client enjoys math and does well in math, as reported by her math teacher. Client has difficulty reading and tested at a second grade reading level. Client has difficulty with her peers as evidenced by clients physical aggression tow ards peers, i.e., slapping, punching, and cursing at her peers. Client has obedient relationships towards teachers and principal as evidenced by hobby directions without defiance.4. Other Social Relationships and Social Roles and Satisfaction. Client reports never having a boyfriend and does not have any friends. Client takes pride in being a mother but is not able to be a mother to her first child due to her own mother not allowing her child to live in their home because of the childs developmental disability. Client has expressed wanting to get her child back. Client does not soon attend a church but fantasizes of participating in the church choir. For generations, African Americans have used spirituality and religion as a crucial instrument for survival (Boyd-Franklin, 2006). One role of the African American church is to act as a refuge, as a sanctuary in an often times unfriendly world (Boyd-Franklin, 2010). Although client does not currently attend church, in her fantasies, s he finds the church as a safe place from her negative and hostile environment.5. Medical/Psychological. Client is pregnant with her second child. Clients first pregnancy resulted in a female with developmental disabilities. At time of clients referral to Each One Teach One, client had not yet seen a doctor for her second pregnancy. Client found out from her mother her father passed away from AIDS and client tested positive for HIV. Clients mother refuses to be tested for HIV because she believes she has not contracted the disease because she and clients father did not engage in anal sex.6. Legal Issues. Client does not have any legal issues at this time.G. ad hominem and Family History relevant to current focusClient was born in November 1971 in Harlem. Mother reported client would sleep in the bed with her and the clients father. Client was bottle fed as a baby, as clients father would drink the breast milk from clients mothers breast. The clients mother reported client was three years old at the time of her first sexual abuse by her father. Client has experienced sexual abuse by her father and mother, and physical and verbal abuse from her mother. Individuals who are of trim back economic status are more likely to experience combat injurytic events, and African Americans are more likely to be of lower socioeconomic status (Gapen et al., 2011). Clients mother reports there is no alcohol or center of attention use in the home.II. AssessmentPsychological FunctioningThe clients intellectual run is at a moderate level as evidenced by grammatically incorrect language and a second grade reading level. In term of the clients psychological drawing, her ego functions are moderately compromised. The egos ability to unify and combine mental processes is called ego functions (Berzoff, Flanagan, Hertz, 2011). Reality testing is the egos ability to recognize and arrest with physical and brotherly reality. The most serious aspect of this function is the ability t o tell the difference between internal reality and external reality (Berzoff, Flanagan, Hertz, 2011). The clients function of reality testing is compromised at times, as evidenced by auditory and visual hallucinations and retreats to her fantasy world. The clients ego function of controlling impulses is also compromised, as evidenced by aggressiveness towards peers.The egos attempt to maintain an accurate level of positive self-worth in the face of stressful or aggravating circumstances is self-esteem linguistic rule (Berzoff, Flanagan, Herzt, 2011). The clients self-esteem could be defined as low due to physical, sexual, and verbal abuse. The clients low self-esteem can be seen through her fantasies of wanting to be someone else, e.g White, famous. Defense mechanisms guard the self from danger, actual or perceived (Berzoff, Flanagan, Hertz, 2011). In terms of defense team mechanisms, the clients defense mechanisms could be classified as immature. The clients immature defense o f dissociation, where a painful memory is detached from the feeling, is evidenced by the clients fantasies of herself stellar(a) a different life (Berzoff, Flanagan, Hertz, 2011).B. Emotional FunctioningBetween nine and dozen months of age children begin to develop Internal Working Models to characterize emotions and expectations resulting from interactions and communication between infant and caregiver (Riggs, 2010). Consistent with the notion frantic abuse negatively impacts Internal Working Models and the ability to regulate affect, re face suggests emotional abuse places children at risk for poor self-concept and disorders of emotional law and impulse control (Riggs, 2010). In regards to the clients emotional functioning, her restrict range of emotional expression and poor impulse control are demonstrated by her use of aggression and anger towards peers. The clients negative coping responses can be seen through her fantasies, as she cannot verbally express how she is feeli ng.According to hamper theory, insecure attachment styles are used because they are accommodative in relation to the behavioral responses of their attachment figure (Riggs, 2010). One type of insecure attachment pattern is disorganized attachment. Disorganized attachment can be connected to child abuse, lack of resolution to trauma or loss by parent, and maternal frightening behavior and psychopathology (Riggs, 2010). The clients attachment pattern can be classified as disorganized due to her experience of sexual abuse, by her mother and father, and physical abuse, by her mother. The clients disorganized attachment can also be attributed to her mothers lack of support in regards to her sexual abuse by her father, i.e., blaming the client for the abuse. Evidence of clients insecure attachment in early childhood can also be seen, currently, through clients dismissiveness, i.e., that she takes care of her mother despite the abuse, low self-concept (Berzoff, Flanagan, Hertz, 2011).C. Social/Behavioral FunctioningAttachment insecurity, due to emotionally abusive parenting, adds to poor social functioning. In early attachment relationships, children begin to develop the skills needed to build future social relationships, such as self-awareness, empathy, negotiation, and conflict resolution. The security of attachment influences many areas of interpersonal relationships, including effectiveness in peer ag roots, reciprocity in relationships, empathy, problem solving, conflict resolution, and establishing close and intimate relationships with peers (Riggs, 2010). The clients social closing off, as evidenced by her lack of peer class, demonstrates the clients insecure attachment with caregivers. The clients lack of distrust in peers and adults is displayed through clients aggressive behaviors.D. Environmental Issues and Constraints Affecting the SituationThe client lives in a neighborhood in which she would consider the ghetto. Client lives with her mother, althou gh the relationship is unstable. Children with a very insecure attachment to their mothers are more likely than other children to live in high-risk families and environments (Kwako, Knoll, Putnam, Trickett, 2010). The client has experienced sexual, physical, and verbal abuse from her caregivers. African American families experience higher rates of poverty than families of other races. Living in poverty increases the risk of exposure to trauma and trauma is found more often in African American populations (Graves, Kaslow, Frabutt, 2010). The clients turbulent home environment, unsafe neighborhood, and lack of social supports and resources exacerbates clients distrust in others, social isolation, and negative self-concept.E. Motivation and Commitment to ServicesThe clients mother does not support client attending school and would rather client take welfare services. Despite the clients mothers lack of support, the client is motivated to attend school to continue her education and be a positive mother for her children.F. Workers arrest of Clients Presenting Situation/ProblemThe client is a sixteen year old, African-American teenage mother of two. The client has experienced severe childhood sexual trauma by her mother and father. The clients two pregnancies are results of sexual abuse from the clients father. The client lacks emotional support from her mother and is often ridiculed by her mother in terms of her appearance, intellectual functioning and overall being. Emotional abuse in the attachment relationship significantly increases the likelihood of developing insecure attachment, which is proven to be link to low empathy and reciprocity, hostility or aggression and impulsivity, exploitation or ridicule by peers, social withdrawal or exclusion from group activities, and general patterns of un-relatedness and isolation (Riggs, 2010).The client lacks any type of social support from peers and, often times, interactions with peers result in aggressive confront ation. Clients distrust in peers and adults is evidenced by lack of nurturing relationships. Up to this point, client has not accessed companionship resources. Previous experience with racism publicly prevents African Americans from accessing aidance and/or services from organizations which historically have safeguarded Caucasians (Graves, Kaslow, Frabutt, 2010). Clients mother is distrusting of community institutions which may lead to clients inability to access support.According to attachment theory, a child forms representational models, i.e., internal working models, of attachment figures, of the self, and of self-in-relation to others based on their relationship with primary caregivers. When a childs caregiver responds in a sensitive, loving, and consistent manner, a working model of other as loving, reliable, and supportive is internalized. On the other hand, experiencing emotional abuse and neglect may instill damaging beliefs about the self, e.g., I am stupid, I am not w orthy of attention, which may result in maladaptive models of self, other, and self in-relation to others. Instead of developing a working model of the self as worthy of jazz and attention, negative models of the self as worthless, incompetent, or powerless may result (Wright, Crawford, Castillo, 2009). Due to the clients mothers unstable and inconsistent caregiving patterns, client has real a low concept of self, as evidenced by the clients feelings of wrongness to have or accept any type of relationships.Although the client has experienced severe childhood trauma, insecure attachments with caregivers, and family and community instability, the client appears to be moderately resilient. resiliency refers to patterns of positive adaptation during or following major adversity or risk (Lopez Snyder, 2011). Faced with two pregnancies, unsupportive and abusive caregivers, and lack of social support, the client continues to be motivated to pursue her education, regain custody of her first child, and become a caring and loving mother to her children.III. Evidenced Based Practice countThis write began the search using the Google Scholar search engine with the term psychodynamic treatment for female African American adolescents of sexual abuse. This search yielded articles related to interventions for substance abuse. The same search term was used again but the term intervention was exchanged for the term treatment. This search yielded articles on cognitive behavioral interventions. This motive thusly moved to using the search engine PsyhInfo. Terms including psychodynamic treatment, psychodynamic intervention, African American, adolescent and sexual abuse were again interchanged to aide in the search. This cause then(prenominal) added the term sexual abuse survivor to the search. This search began to yield interventions related to psychodynamic interventions. This reason began finding articles related to psychodynamic groups as a psychodynamic interventio n.Continuing to use the PsychInfo search engine, this author then used search terms psychodynamic groups, adolescents, sexual abuse survivor and African American. This author was able to yield articles related to psychodynamic groups. This author then moved to using the University of Southern California Library to continue the search. This author again used the terms psychodynamic groups, adolescents, sexual abuse survivor and African American to yield further articles in regards to psychodynamic groups. This author was able to accumulate six articles in regards to psychodynamic group intervention. Overall, this author found it extremely difficult to find, in the literature, psychodynamic interventions special to African American adolescents who have experienced sexual abuse.IV. Intervention PlanIn the first years of childhood, the family is responsible for the care and development of the child. In brawny families, children learn they can depend of their environment to provide emo tional security and physical safety. Children then gain behaviors which allow them to nurture their own emotional and physical health free from parents or caregivers. Poor health also can develop early in life. Children who live in families with characteristics such as family conflict, i.e., frequent episodes of anger or aggression, and lack of nurturing, i.e., relationships which are cold, unsupportive, and neglectful, can have negative consequences on mental and physical health (Repetti, Taylor, Seeman, 2002). Unfortunately, due to clients exposure to an abusive and un-nurturing environment, she has developed poor mental health, as seen by her moderate level of defense mechanisms, poor self-concept and lack of support.Due to the clients insecure attachment with caregivers, which has led to lack of support and untrusting nature to others, the intervention employed will be psychodynamic group psycho cures. Because of clients young age, client will be more suitable for time limited psychodynamic group psychotherapy, which occurs between twelve and thirty sessions (Wise, 2009). The format used for psychodynamic group psychotherapy is verbal. The basis of the group should be to feel and talk, rather than act. Because it is a psychodynamic therapy, the healer should wait for the group interactions to occur freely and then comment when appropriate (Wise, 2009). During the process of psychodynamic group psychotherapy, the therapist will attempt not to set agendas but follow the suggestions of the group. The belief is the group process will eventually lead to the most emotionally charged subjects if allowed to proceed without interruption. The therapist in the psychodynamic group psychotherapy session will attend to the group and individual members based on how the session begins (Rutan, 1992).The implementation of the psychodynamic group psychotherapy intervention is community based, therefore the client will need to access community organizations to utilize the treatment intervention. As previously noted, the client has not accessed community resources thus far. Another hurdle the client will have to overcome in order to maximize optimum results from the psychodynamic group psychotherapy intervention is a proper match to therapist leading the group and participation. Because client is untrusting of other others it may be difficult to engage client in group psychotherapy process. A therapist who creates an environment of acceptance, understanding and trust, and provides empathy and responsiveness will have a better chance of keeping and engaging challenging members (Gans Counselman, 2010).The remainder of psychodynamic group psychotherapy is to make aware parts of the unconscious which result in negative distortions in present day perceptions (Rutan, 1992). Furthermore, goals of treatment are to assist in overcoming resistance to experiencing, expressing and understanding emotion. The psychodynamic group psychotherapy model allows for res olving the tension between suppression of emotions and explosiveness. The group format also allows for members to work together to manage and contain feelings (Wise, 2009). This aspect of psychodynamic group psychotherapy will be beneficial to client, as she has difficulty expressing her emotions, as evidenced by aggression towards peers. Although the client will gain emotional regulation skills through the psychodynamic group psychotherapy intervention, this will not be her main treatment goal.Psychodynamic group psychotherapy is also another way for individuals to interact deep down a system of relationships. This is beneficial due to most presenting problems having a relational context. Allowing individuals to interact and then reflect gives the individual the opportunity to use the group as a place to observe and change patterns (Wise, 2009). The client has expressed a desire to have safe, nurturing and loving relationships with others, but due to low self-concept does not feel worthy of such relationships. The clients goal for psychodynamic group psychotherapy will be to increase number of quality relationships from zero to at least two by the conclusion of the group sessions. The clients relationships will be measured by her own self-report, as well as therapist observations of her interactions and relationships with fellow members of the group and development of social skills.The catalyst for change in psychodynamic group psychotherapy includes change by imitation, i.e, learning by observing others, identification, i.e., unconsciously taking on traits or characteristics of others, and internalization. The therapeutic process develops using confrontation, explanation, interpretation and working through (Wise, 2009). Additionally, other therapeutic aspects which are addressed include support, self-revelation, learning, and self-understanding, with interpersonal learning as the utmost important (Wise, 2009). Because the client has developed negative inter nal working models, due to insecure attachment with caregivers, i.e. mother and father, the interactions with others in the group setting may begin to assist client in developing higher self-concept and more nurturing relationships.V. Discussion, Analysis and Rationale for Interventions ChosenPsychodynamic group psychotherapy was chosen as the intervention for the client due to her experience of sexual abuse by caregivers. Time limited, as well as ongoing psychodynamic group psychotherapy has been effective in treating women with a history of sexual abuse, due to the opportunity for the individual to reduce the feelings of isolation, guilt, and shame. An individual is able to effectively work through feelings when the individual is able to component their experience in a therapeutic environment comprised of compassion and acceptance. The psychodynamic group psychotherapy process provides an individual with the ability to incorporate a new mark experience without devaluation or rid icule, while at the same time abandoning previous attachments which were associated with the original event and emotion (Nusbaum, 2000).When an individual is abused, the person tends to identify with the unloving, aggressive, and immoral characteristics of the superego rather than the gentle, loving and overprotective characteristics. The individual may interpret the caregivers failure to nurture and protect adequately as a sign they are unworthy and unlovable (Nusbaum, 2010). Evidence of these characteristics can be seen in the clients low self-concept and feelings of unworthiness to have any type of relationship. Within the psychodynamic group psychotherapy process, the group can demonstrate appropriate levels of protectiveness, love and concern to its members. Negative feelings often experienced by individuals with sexual abuse can often be eased through disclosure of the traumatic experience. The group can then provide corrective superego functions by not allowing its members t o blame themselves for the experience, which may have been unavoidable and not their fault (Nusbaum, 2000).Psychodynamic group psychotherapy also deepens the alliance between group members and facilitates the development of relationships which can be observed and analyzed in the context of interpersonal fears and roadblocks. Furthermore, in psychodynamic group psychotherapy individuals can identify interpersonal conflicts and work through primary defense structures which are run by fears of trusting. Additionally, because abuse and neglect tend to occur in nonadaptive families, by successfully working through emotional conflict the psychodynamic group offers the opportunity for interpersonal learning and development of social skills, which are usually not modeled in dysfunctional homes (Nusbaum, 2000).This author is unable to implement the psychodynamic group psychotherapy intervention with the client but can visualize how the intervention would offer with the client. In the first sessions this author would attempt to create a trusting, nurturing and safe environment where client would feel she could engage in the group process and share personal experience. According to psychodynamic theory, personality is formed developmentally. In this model each stage of development builds on the previous stage and each stage affects the following one. It is important to note in the therapeutic process, defects in earlier developmental stages can be corrected if that stage can be recalled, relieved and be affectively re-experienced and corrected in the here and now (Rutan, 1992). It will be pivotal for the clients treatment for her to share feelings, emotions and past experiences in order facilitate positive transformation.This author would predict the client would be difficult to engage initially due to her mistrust in others and feelings of unworthiness. After consistent nurturing, accepting, trusting and safe experiences in the psychodynamic group, this author would se e the client begin to engage in the group process. Once the client begins to share personal experiences, feelings and emotions this author would utilize a specific intervention, the here and now. The here and now technique would allow this author to use the clients past experience to understand and explain occasions when she unconsciously repeats the past or misperceives the present based on what she has learned in the past (Rutan, 1992). This technique would allow self-learning and self-understanding in regards to how her past abuse and neglect as affected her current relationships.This author expects transference will likely surface in the therapeutic process with the client. Transference can be defined as the misrepresentation of present object relationships on the basis of early object relationships (Rutan, 1992). Transference will be beneficial in the therapeutic process with the client. It will allow for this author to fall in information and explore the nature of early relat ionships based on the characteristics the client transfers on to this author (Rutan, 1992).Through the psychodynamic group psychotherapy process the clients main goal will to be to form quality, nurturing and trusting relationships. Relationships are important in forming personality, causing psychopathology, and curing psychiatric symptoms. As individuals develop in the psychodynamic group they are forming important relationships and, while doing so, every part of their character is emerging. Individuals reveal their defense mechanisms and transferences while, in turn, receiving feedback from the therapist and other members. There may not be any other therapeutic process where so much data is available to an individual about themselves as in psychodynamic group psychotherapy (Rutan, 1992).