In this article I present a few personal experiences I had with clients early in my career. Instead of concrete interventions, I discuss some of the work I did, my successes and failures, and its impact on me and my clients. I invite our readers to use these examples as tools to think about what intervention(s) and theories that were discussed in earlier articles you think would be most effective in helping you understand and treat these clients.
Personal Social Work Experience with Adolescents
and Case Presentations:
For purposes of confidentiality, all names in this article have been changed.
a) Case #1: Norman
While working in a Hostel, or group home, I was given Norman as a client. Norman was a 24 year old male who had suffered brain damage after falling from a roof at age 18. His issues were not initially noticeable, as he has no physical indications or speech impediments. After reading his bio-psycho-social, I understood that Norman had the mental capacities of an eighteen year old, which was the age he was when the accident occurred. As a result of the trauma of the accident, both physical and emotional, Norman had experienced an “arrested development”, meaning that he was “stuck” in adolescence. Using what I have presented in previous articles about developmental stages, I took another look at Norman from his cognitive stage as opposed to his physical developmental stage, as an adolescent rather than an adult. Using Erikson’s psychosocial theory was helpful in helping me to understand Norman. Many of his frustrations were connected to his development of sense of self and identity, especially in terms of career and religion. By understanding his functioning level and the tasks and processes he was attempting to mediate, I showed Norman that I was making an effort to understand where he was coming from, when most other staff did not seem to succeed to do this.
Ultimately, Norman terminated our sessions earlier than we had planned because as he distanced himself from his observant upbringing, he felt uncomfortable with me as I am an observant individual. This was a blow to me, as I felt I had built a rapport with Norman, and he had never mentioned any of these issues with me. I found out from the Agency, that Norman did not want to continue to work with me. The authorities at the Center did not allow me to have a final session with Norman to facilitate a proper terminattion, because of his strong reactions and feelings. Although we had never discussed religion, I felt guilty for making Norman uncomfortable. This really brought home issues of how teens perceive those offering help, and possible transference and counter-transference issues. In the end, I decided I have to be comfortable with myself, and it is our job as a social workers to be accepting, but we will not be accepted by every client. Growth and developing as a professional, it is important to realize how complex relationships can be and how crucial it is for the practitioner to be self-aware and open to many possibilities in offering assistance.
Case #2: Judah
Judah, 18, was originally sent to me as a case management client. Born in the U.S. to Israeli parents, he was unsure about his status as an Israeli citizen. Judah impulsively went to the ministry of interior to try to clarify his status, where he accidently became a full-fledged citizen and was required to serve in the army. Judah came for assistance in dealing with his citizen status and his responsibilities as an inductee to the Israeli army.
After three months of much discussion, advocacy and active interventions on my part, we worked out his citizenship and army issues. Through the rapport we built, I had come to know Judah fairly well, and so at this point I asked Judah if he now wanted to re-contract and possibly work on different goals since we had accomplished our concrete goals, what we had originally set out to do. I mentioned some things I thought were issues: like his impulsiveness; and what appeared to me to be an inability to cope with anxiety provoking situations. Judah agreed, and we began another four months, now of more clinically focused meetings.
Informed by what I had learned in casework and pathology, my theoretical readings, and my discussions in supervision, my instinct was validated when Judah disclosed that he has a history of anxiety and was prescribed anti-depressants. We used our time together to do some Cognitive Behavioral Therapy, discussing his fears and anxieties, challenging his assumptions, and exposing him to situations he previously avoided. We also utilized psycho-education. Judah and I discussed the biological aspects of anxiety and panic disorders. He realized that the anxiety was not provoked by situations he could not handle, but escalated and abated on its own. This was why Judah could never pinpoint the exact trigger of the anxiety or the solution that helped him through it. Knowing that the anxiety would eventually end helped to take much of the edge off Judah’s anxiety. We also discussed anxiety reducing techniques, such as breathing exercises. Once, when Judah almost used drugs to self-medicate through an anxiety episode, we discussed how self-medication, though might solve his current problems, might also exacerbate them in the long run. In ten years, Judah hopes that will not want or have the need to self-medicate, rather he wants the skills to deal with his anxiety. Judah began to understand that if he continued this type of behavior he would never learn the important tools that he wanted and needed for his future.
By the end of our formal working relationship (give date), Judah had overcome his anxiety and was able to sit for the General Educational Development (GED) exam, which awards the equivalent of a U.S. high school diploma. He had repeatedly missed taking this exam because of his anxiety, and now he would receive his high school diploma.
This case demonstrates how important it is to trust your intuitive instincts, began to build my professional interventions and skills, and realized the powerful impact you can have on someone in a short time.
Case #3: Justin
Justin was a sixteen year old student from Australia. After years of rebelling and acting out in his local community, his sister paid for him to leave home and study in Israel. He was asked to leave three Yeshiva institutions before I met him ‘on the street’ during my outreach work. He was currently homeless and broke. He had no interest in returning to an observant institution as he was distancing himself from his religious past. His parents had cut off all communication with him and this time gave him no financial or emotional support.
I initially worked with Justin in the Employment Center trying to help him find a job so he could find a way to support himself. I concurrently had therapy sessions with him, in which he revealed very little about himself personally, and always wore a hood. After only a brief period of our working and meeting together, Justin was arrested for credit card fraud.
Apparently, Justin was ‘taken in’ by a few teenagers he had met in a bar. They allowed him to sleep in their quarters and seemed to accept him socially very quickly. In February, Justin stole one of his new friend’s credit cards and used it to furnish this same friend’s apartment and buy him dinners. While doing this Justin would give stores a copy of his passport, definitely setting himself up to be caught.
I met Justin at the courthouse for his hearing. I discussed with the police and the judge my professional relationship and sense of progress with Justin. Justin was placed under house arrest with a nearby relative. I continued to visit him there and conducted focused sessions with him.
It was during these sessions, which was after 3 months of our meetings, that Justin finally took off his hood, perhaps signifying that he was finally exposed and had nothing else to hide. He shared with me that his mother had been diagnosed with a borderline personality disorder, and growing up at home was very difficult. His parents want him to be something he is not, and this has always caused him great inner conflict. He confessed to ‘setting himself up to get caught’, saying he had done other “scams” in the past but had been a lot more careful about it. When I asked him about his lost friendships, he expressed sadness, but kept up a cool exterior. It was the closest to a genuine emotional expression that I had ever seen Justin exhibit in session.
Treating Justin was truly a challenge, and required incorporating and applying multiple theories to understand his complexities. Erikson’s psychosocial theory was helpful in looking at Justin’s current position and how he was attempting to mediate between his emerging self-identity and the need to join a welcoming peer group. Piaget’s cognitive theory gave me insight into Justin’s cognitive capacities. Although he was very bright, could think critically and problem solve, he still set himself up to be caught, which enabled me to understand how needy Justin actually was. Freud’s psychosexual theory was useful in addressing Justin’s childhood experiences and relationships, and how these troubling past experiences were manifesting through his current behaviors. However, time constraints only allowed us to begin to touch Justin’s main issues, to ‘scratch’ the surface of this young man’s personality. Kohlberg’s theory of moral development shed light on Justin’s moral reasoning, and how he was unable to view his behavior towards his only friends accurately.
Again, though we were constrained by time, I believe we accomplished much in understanding the nature of Justin’s relationships with his parents and siblings and how his family functions or perhaps more accurately dysfunctions as a unit.
Self awareness of these issues are critical in developing a therapeutic relationship, especially with Teens-At-Risk.
Justin also challenged my sense and commitment to ethics and values, as teens-at-risk often do. He felt he had done nothing wrong by stealing his friend’s credit card. It was initially difficult for me to accept him for who he was and not apply my own set of values to evaluate what he had done. Through supervision, I was able to separate my values from Justin’s, and be ‘there’ for him in session, focused completely on Justin. This was not easy for me, but I do value the learning that I experienced. It is critical to have good supervision when working in a theraputic relationship.
Engaging Justin in session was at times difficult as he was always in need of my help but was ambivalent about accepting my help. Conveying empathy was difficult because Justin showed no emotion and seemed to express little care or interest for what was happening to him.
By the time of termination, Justin still had many issues, and I felt like I was abandoning him, but the realities of our relationship was that there existed a limit on how many sessions we could have. It was a difficult transition to ‘hand’ Justin over to another professional. Still, the fact that we had a positive therapeutic relationship had opened Justin to the possibilities of more therapy and possibly sorting and working out his issues. In reflecting on my work with Justin I would like to believe that he gained a great deal from our sessions together.
Conclusion
Working with adolescents can be challenging but rewarding. Because of the growth that these teens are experiencing in multiple areas of development, it often requires the application of numerous theories to understand their whole picture. This is all the more so when dealing with teens-at-risk, who in addition to the normal conflicts of adolescence present with numerous other issues, making their treatment more complex and sometimes very difficult.References
Abadinsky, H. (2001). Drugs: An introduction. Belmont, CA: Wadsworth.
Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens
through the twenties. American Psychologist, 55, 469-480.
Aronfreed, J. (1969). The concept of internalization. Handbook of Socialization Theory
and Research. Chicago: Rand McNally.
Bandura, A. (1977). Social Learning theory. Englewood Cliffs, NJ: Prentice Hall.
Bronfenbrenner, U. (1995). Developmental ecology through space and time: A future
perspective. Examining lives in context: Perspectives on the ecology of human development, pp. 619-647. Washington, DC: American Psychological Association.
Clancy S. M. & Dollinger, S. J. (1993). Identity, self, and personality: Identity status and
the five factor model of personality. Journal of Research on Adolescence, 3, 227-246.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders
(4th ed.). Washington, DC: American Psychiatric Association.
Elkind, D. (1967). Egocentrism in adolescence. Child Development, 38 1025-1034.
Erikson, E. H. (1963). Childhood and Society. (2nd ed.) NY: Norton.
Erikson, E. H. (1959). The problem of ego identity. Psychological Issues, 1, 101-164.
Farmer T. W. & Rodkin, P. C. (1996). Antisocial and prosocial correlates of classroom
social positions: The social network centrality perspective. Social Development, 5, 174-188.
Gray, W. M. (1990). Formal Operational Thought. Reasoning, necessity, and logic:
Developmental perspectives. Pp. 227-253. Hillsdale, NJ: Erlbaum.
Greif, E. B., & Ulman, K.J. (1982). The psychological impact of menarche on early
adolescent females: A review of the literature. Child Development, 53, 1413-1430.
Hepworth, D. H., Rooney, R. H., & Larsen, J. A. (2002). Direct social work practice:
Theory and skills. Pacific Grove, CA: Brooks/Cole.
Holmes, D. S. (2001). Abnormal Psychology. Needham Heights, MA: Allyn & Bacon.
Inhelder, B. & Piaget, J. (1958). The growth of logical thinking from childhood to
adolescence. NY: Basic Books.
Kassin, S. (2001). Psychology. Englewood Cliffs , NJ: Prentice Hall.
Kohlberg, L. (1981). Essays on moral development: Vol. 1. The Psychology of Moral
Development. NY: Harper and Row.
Kohlberg, L. (1973). Moral stages and moralization: The cognitive-developmental
approach. Moral Development and Behavior. NY: holt, Rinehart, & Winston.
Mau, R. Y. (1992). The validity and devolution of a concept: Student alienation.
Adolescence, 27, 731-741.
Mischel, W. (1973). Toward a cognitive social learning reconceptualization of
personality. Psychological Review, 80, 252-283.
Newman, B. M. & Newman, P. R. (2003). Belmont, CA: Wadsworth/Thomson Learning.
Piaget, J. (1932/1948). The moral judgment of the child. Glencoe, IL: Free Press.
Spear, L. P. (2000). The adolescent brain and the age related manifestations. Neuroscience and
Biobehavioral Reviews, 24, 417-463.
Turiel, E. (1983). The development of social knowledge: Morality and Convention.
Cambridge, England: Cambridge University Press.
No comments:
Post a Comment