Paradigms of Clinical Social Work

Emphasis on Diversity

Rachelle A. Dorfman-Zukerman, Ph.D., Melinda L. Morgan, Ph.D., Phil Meyer, Rachelle A. Dorfman-Zukerman, Ph.D., Melinda L. Morgan, Ph.D., Phil Meyer

• Editorial: Routledge
• Año: 2012
• ISBN:
  9781135946203
• Edición: 1
• Categoría: Psicologia
• Categoría: Psicologia clinica

Designed to mirror how social work theory and practice is taught, Paradigms of Clinical Social Work, Volume 3 presents new therapeutic models through an imaginary family experiencing common social work problems.

Part I

The Case

1

The Case

Rachelle A. Dorfman, PhD

THE FAMILY

T he problems of the Shore family are common ones. Among them are unemployment, illness, and the worrisome behavior of the children. What is uncommon is that the problems never get resolved. Although the family members frequently seek help and are the recipients of various social services, they never seem to function free from symptoms. Individually and collectively, their lives are marked by crisis and emotional distress.

Nancy is 43; her husband, Charley, is 51. The children are Rena, 18, who was adopted as a baby, and Michael, 12. Until recently, the entire family lived in the two-unit duplex they own. Nancy, Charley, and Michael still live in the second-floor apartment. Rena, who occupied the first-floor apartment by herself since she was 13, has moved out; she lives nearby and is “on her own.” Charley has been chronically unemployed for 4 years; the family survives largely on the disability checks Nancy has received every month for the last 10 years.

Nancy is a large woman. She calls herself “grossly obese” and makes frequent apologies about her appearance. Her hair is graying and her figure is decidedly matronly, but her flawless skin and the gap between her front teeth give her a youthful quality. The only reservation she has about being interviewed is that “After it's done, I will probably run from social worker to social worker trying to do everything suggested.”

For most of her 23-year marriage to Charley, “trying to get everything fixed” has been her full-time job. She is at her best during family crises. “Then,” she says, “I take control. I no longer dread the terrible things that might happen because they have already happened. It is the waiting for the crisis to occur that makes me worry.” Her anxiety often turns into panic. She becomes nearly immobilized. Unable to leave the house, she chain-smokes and imagines the worst of all possible outcomes. Anxiety attacks occur daily.

There is no shortage of crises. Recurring flare-ups of a back injury that Nancy suffered as a young nurse incapacitate her without warning, confining her to bed for weeks or months. The flare-ups are not the only crises. Three times, doctors predicted that Michael, asthmatic since early infancy, would not survive until morning. Twice Rena ran away from home and was missing for several days.

The small apartment reverberates with the sounds of their crises. One typical scenario began with an argument. Rena, then 16, lunged forward to hit her mother. Charley, in frustration and fury, pulled Rena away from Nancy and beat her, bruising her face badly. It was on that evening, 2 years ago, that Nancy and Charley told Rena she would have to leave when she turned 18.

A new problem with a potential for crisis is emerging. The downstairs apartment—which is now vacant—has never before been occupied by strangers. (Before Rena, Nancy's elderly grandparents lived there.) Because they need the money, Nancy and Charley have decided to rent it to a young couple. Nancy is anxious about being a landlord. She is trying to train Charley and Michael to keep their voices down and their steps light. She wishes that her family lived downstairs and the tenants lived upstairs and says, “I'd rather they walk on me than we walk on them.” Again, she fears the crises that are certain to erupt.

Rena has been in her own apartment a few blocks away for 3 months. Nancy worries about that, too. She feels that as an adopted child, Rena is especially sensitive to being “put out.” Nonetheless, she still argues with Rena about her “laziness” and failure to finish anything, but there is less explosiveness now that she is on her own.

Despite some relief in the tension at home since Rena left, Nancy is still anxious and often depressed. She has gained 15 pounds, sleeps poorly, cannot concentrate, and is forgetful. Most of the time, she stays inside. Outside, she feels that people make disparaging remarks about her; only at home does she feel safe. Her days are filled with baseball games on TV, soap operas, needlepoint, and worrying about what will happen next.

Charley is blond, tall, and broad-shouldered. It is not difficult to imagine that he was once quite an appealing young man. When he was 27, his dreams and schemes interested and excited Nancy. Occasionally, he still talks of outlandish inventions and “get rich quick” schemes. The difference is that his wife no longer believes in him or his dreams. To her, they are annoying at best and embarrassing at worst.

Charley says, “All I ever wanted was to be somebody. I just want to be known for something, to have someone walk by my house and say, ‘That's Mr. Shore's house.’” He boasts about the time he went to California “to become a movie star” and of all the rich and famous people he knew and still knows. He speaks wistfully of “just missed” opportunities for stardom and of inventions that no one took seriously. He likes being interviewed, saying, “It's exciting.” Nancy reminds him that the interview is for a clinical book, not a Broadway play.

Five years ago, Charley performed on amateur night at a downtown comedy club. Nearly every Thursday night since then, he has performed for free in front of a live audience, using the name Joe Penn. His pride is unbounded when he is recognized in public as Joe Penn. Occasionally, someone will even ask for his autograph.

His wife supports this activity because it makes him happy, but her perspective on his act is somewhat different from Charley's. The show embarrasses her. She says that although it is true that the audience laughs, they laugh at Charley, not at his jokes. “He is not funny,” she maintains. Charley's defense is that probably the wife of Nancy's favorite comedian doesn't think her husband is funny, either.

Over the years, Charley has had scores of jobs. He was a salesman, a janitor, a self-employed carpet cleaner. Even though he lost jobs regularly, until 4 years ago he never had a problem getting a new one. Several times in the last 3 months, Charley has mentioned suicide, always in response to a suggestion that he, like Nancy, should get on disability because of his “condition.” Charley says that he would rather die first. Although he seems serious about this statement, he has no plan or means in mind.

The condition is the bipolar depression that was diagnosed 2 years ago at the time of his first and only psychotic break and consequent 4-week hospitalization. “I always got depressed,” he recalls, “but that was different. That time I really went off.” Remembering his grandiosity and manic behavior, he says, “I guess you do those things when you are sick.” He is maintained on lithium.

A “firing” precipitated his break. He had completed an expensive cooking course and was determined to prove he could “make it” in his first cooking job. He says he hit the chef when he could no longer tolerate the man's calling him names. (His bosses have complained that Charley is too slow and talks too much.)

Since his illness, he has had fewer grand ideas—he just wants a job he can hold. When he does allow himself to dream, mostly he dreams the way he did when he was a child, quietly and by himself. He likes to daydream while he works, which affects his performance. He was fired from his last janitorial job for forgetting to lock all the doors and for not cleaning thoroughly.

Presently, Charley attends a vocational rehabilitation program, where he receives minimum wages for training in janitorial services—a job he says he already knows how to do. The program's goals are to develop the work skills and interpersonal skills needed for employment and to place him successfully in a job. Nancy is pessimistic about the outcome. She is angry because no one will tell her the results of his psychological testing. She says that if she knew for certain that Charley wasn't capable of holding a job, perhaps she wouldn't be so angry with him.

About Nancy, Charley says, “She is the best wife in the world, the same as my mother.” She even worries like his mother, he says, “but I don't always like that because I don't feel like a man.” The duplex they own was given to them by Nancy's Aunt Flo. Although Charley appreciates the generosity, he says, “I wanted to do that. I wanted to buy the house.”

Nancy agrees that she is parental. She prefers to handle important matters herself, not trusting Charley's competence with dollars, documents, or decisions. She complains that when she sends Charley to the store for two items, he invariably comes home with one of them wrong. But most of all, she complains about not having enough money to pay the bills. “I worry and he doesn't give a damn.” Charley says privately, “I worry, too, but I act like I don't because there is nothing I can do.”

The couple frequently fight about Charley's compulsive lying. He tells Nancy what he believes she wants to hear, claiming he doesn't want to upset her with the truth. He says he would like to stop, but he doesn't seem able to.

Charley usually stiffens as soon as he approaches the front door of his house. “Will there be a problem? Will Nancy complain about bills? Will Michael come home from school beaten up? They will want me to solve the problems. But I can't.”

Being a father has been especially difficult. Charley and his son bicker and fight like small boys. Nancy finds herself storming in, breaking them up, and scolding them both. She says that each one fights for her attention, trying to outdo the other.

Because father and son tend to relate to each other like siblings, therapists who worked with the family in the past attempted to restructure the relationship by suggesting that Charley teach Michael how to fish and play miniature golf. Charley and Michael always returned home from such outings angrily blaming each other for ruining the day. Nancy says, “The whole time they are out, I am in a knot worrying that they are going to come up the steps screaming. I am never disappointed.” She wants Charley to act more like a father. Charley wants that, too. But, he says, “Sometimes you just don't think about what you're doing when you do it.”

Twelve-year-old Michael is tall and gangly. When he speaks, one can hear the phlegm rattle in his chest. It seems as though his voice is echoing through the mucus. His habitually knitted brow and his glasses make Michael appear very intense. He talks about “feeling funny” and “feeling bad.” He feels bad because “asthma has taken away part of my life.” His theory is that God gives everyone something he or she is terrific at. He says, “I haven't found mine yet— the asthma keeps me from it. I can't be a great athlete because I can't run fast. I can't have a puppy because I would wheeze. I just want to be good at something.” According to his theory, God also puts a scar on everyone. People have to overcome their scars before they can find their special thing. Michael says asthma is his scar and he is waiting to outgrow it so that he can “find himself.”

In the meantime, he is unhappy and lonely. Attempts to make friends are unsuccessful. He feels that even when he tries to behave himself, it is useless because his reputation prevents the other kids from relating to him in a new way. They still tease and pick on him. If someone hits him, he neither hits back nor runs away. He just “stays.”

When he is not being “silly,” he is more successful in relating to adults. Always attuned to the news, he usually knows what is current in world events, politics, and business. He sympathizes with underdogs and people who are victims and talks about becoming a psychologist so that he can help them. He is fiercely patriotic and always truthful. When asked why he tells the truth when a lie would avoid trouble, he says, “I am a Boy Scout; I cannot tell a lie.”

Scouting is the highlight of his life, but there is trouble there, too. Camping trips require a level of coordination, self-control, and social skills that he doesn't have. He gets reprimanded when he puts his tent up wrong or ties his neckerchief incorrectly. When this happens, he says, the other scouts laugh and he feels like a fool.

In junior high, Michael is in a learning disability class. Although learning disabilities and special classes are part of his history, the current placement was not made because of them; tests show that he has overcome or outgrown any learning disability he had. The problem that still lingers and prevents him from being “mainstreamed” is his poor social judgment. The same behaviors he calls “silly,” his teachers have called “bizarre.” These include touching others, making strange noises and motions, and laughing too loud or at the wrong time.

Last summer, Michael went to overnight camp. This spring, his parents received a disturbing letter from the camp. Michael was not invited back. The reason given was more than the typical foul language and mischief of 12-year-old boys. Counselors complained that at mealtimes he played with the utensils and the plates, poured things into the pitchers and the bowls, and threw food. He did not get along with the other campers and was seen as the instigator of most of the problems that occurred that summer. The staff felt that when he wanted to behave, he could, and that he willfully chose to misbehave.

Michael reports the situation differently. One moment he says that he acts “silly” because he falls under the influence of others. A moment later he suggests that he acts that way so that others will like him. Still later he says, “I don't really want to act like that. It's really kind of stupid. I don't know why I do it.”

Michael is ambivalent about his sister's leaving. He agrees that it is more peaceful at home, but now his parents are fussing about him more than ever. Nancy estimates that she spends “80% of her worrying time” agonizing about what will become of Michael.

Rena, four blocks away in a basement efficiency apartment, has agonies of another sort. She is attractive, intelligent, and talented. Everyone, including Rena, always expected that she would be successful. But in the last few years, no matter how promising her beginnings, she eventually either quit or failed at everything she started.

With 31 cents in her purse and no job, she is overdrawn at the bank and can't pay her bills. She has taken loans to pay for college courses she never completed. Rena feels old and tired.

Her parents used to call it laziness when she refused to go to school and stayed in bed until midafternoon. They thought she was lazy when she dropped out of high school, got a GED, and enrolled in pre-med—only to drop out of that. They believed that if they allowed her to remain at home, she would “vegetate” and do nothing at all.

Nancy pressures Rena to “go to therapy” because she has come to believe that there must be something more seriously wrong with Rena than “laziness.” Rena has agreed to go for therapy, partly because one usually does what Nancy wants. “Mother,” she explains, “has a way of making you feel so bad and guilty, you finally either do what she wants or are mad because she makes you feel so bad.” Rena has also agreed to go because she is lonely and confused. Unfortunately, there is a waiting list for outpatient services at the community mental health clinic—and Rena's name is at the bottom of that list.

Nevertheless, it seems that the therapeutic process has already begun. Rena writes her thoughts in her journal every day and spends hours wondering about why she is the way she is. She is happy to be interviewed because she says she needs to talk about “this stuff.”

She remembers when she didn't want to talk about “this stuff” or even think about it. At 16, when the adoption agency—at her request—sent some information about her birth mother, she forced hersel...

Índice

• Front Cover
• Half Title
• Title Page
• Copyright
• Dedication
• Contents
• Foreword
• Acknowledgments
• About the Editors
• About the Contributors
• Introduction
• Part I The Case
• Part II Paradigms of Clinical Social Work: Emphasis on Diversity
• Part III: Epilogues
• Author Index
• Subject Index