I am Emily’s case manager and I also run one psycho therapy group in addition to three DBT therapy groups daily which Emily will attend. I work with Emily to put together her initial treatment plan, identify goals, strengths and abilities. I then meet with Emily daily to go over her treatment plan, update goals if needed and talk about her overall progress. I will also work with Emily to find aftercare providers such as a therapist and psychiatrist. Emily is the first patient that I have worked with independently. While she does not know that, I am acutely aware. I have made sure to document absolutely everything she says to me so I can report back to my supervisor and ensure that I am completing her treatment plan correctly. I have found that I take her successes and failures personally and have had to utilize supervision to keep these emotions in check. I realize that Emily looks to me as someone with power and knowledge to help her. I am new to social work and I often worry that I will miss something important or make a mistake. Supervision has been critical for me to maintain my self confidence while meeting my patients needs.
Since working with Emily, our relationship has grown from when we first met. Emily seems to trust me more than she did when she first came to the hospital. When I first met Emily she was extremely sad and had a
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difficult time getting through a conversation without crying. She had many discrepancies in her stories each time we spoke. For example, when I first met with Emily she told me that she was not on any medication nor had she ever been on any. I remember feeling perplexed by that statement; Emily had been suffering from depression since the age of twelve and was diagnosed with Major Depressive Disorder. Later that day I met with Emily and the doctor and she told us that she had been prescribed medication but had stopped taking it four months ago because she did not like the way she felt. When Emily would tell me a story it tended to feel incomplete and felt as though she was leaving something out. During our initial meeting, Emily told me how her best friend in high school stopped talking to her in her junior year and then proceeded to bully her throughout high school. She was still upset because she never really knew why she stopped talking to her. Emily proceeded to tell me that she started dating her bullies’ brother this past May and they had a falling out in July. She made a comment under her breath about dating them both. At our first meeting I did not feel comfortable questioning her about the comment but I wrote it down to discuss at a later meeting. As our relationship has progressed and Emily is starting to open up more, she has shared with me that her feelings for her best friend went deeper than just a friend. She revealed that dating her ex-friend’s brother was a way to get closer to the friend. The beginning of my relationship with Emily was difficult because I was not sure if she was telling me was the truth. Emily was guarded and told half truths and I had to tweeze through the stories that she told me. I understood that she did not trust me and was not ready to tell me everything; she was testing me to gauge my reaction to her. There is more to learn about Emily, and I am hopeful that as we work together she will realize that I will not abandon her like her best friend in high school and our therapeutic relationship will continue to grow. As I have been working with Emily, I have noticed her resistance to change. It seems as though she is comfortable with being depressed, I suppose this is because she has been depressed for most of her life. However, I do see that this may be a challenge in our relationship and her recovery. I will have to keep myself in check and remind myself that I cannot work harder than Emily. The program Emily is in uses Dialectical Behavior Therapy in a group setting. All patients are required to attend four groups daily. Patients will also meet with their clinician on a daily basis to assess goals and update the treatment plan if needed. There are multiple areas that need to be addressed while Emily is in the program. The first is working with the doctor to stabilize her medication. Emily shared with the doctor that her medicine made her feel like a different person and that is why she took herself off. The doctor prescribed Effexor and we will monitor her symptoms of depression. Other areas that Emily has expressed an interest to work on are reducing her anxiety, racing thoughts, mending past relationships, enhancing current relationships, effectively coping with disappointments, dealing with trauma and letting go of the past. Emily reports she is a hard worker, a good listener and she is a good friend. These are a few of her positive qualities and strengths which will help her to reach her goals. Emily is confident that she is able to advocate for herself with friends and family if she is feeling really sad and needs help. Emily feels as though her parents do not truly understand how she feels or that her depression is real. While she knows that they care about her she feels they do not address the depression and they have told her multiple times that she will outgrow it or it will go away once she finds a job. Emily has expressed her desire to have her parents involved in her treatment. Emily went to school to become a graphic designer and has shared with me that she is extremely passionate about the work. She was extremely happy at her internship and is excited to work on herself so she may find a job. Emily’s goals represent change in micro and mezzo levels. During her stay in the partial program Emily will learn DBT skills to enable her to effectively deal with anxiety, depression, interpersonal relationships and past trauma. Emily will first focus on herself (micro) and then work on relationships (mezzo.) Identifiable objectives to help Emily reach her goals are reducing her depression and anxiety. Involving Emily’s parents in her treatment plan and recovery is an important goal to Emily as well. This partial program uses Dialectical Behavior Therapy (DBT).
DBT is based on four concepts; distress tolerance, interpersonal effectiveness, mindfulness and emotion regulation. Emily will benefit from all four concepts. Distress tolerance teaches effective coping skills to effectively deal with disappointments, stress and change. Emily reported that her depression got significantly worse when she was not hired permanently at her internship. Going forward Emily will be able to utilize skills such as self soothing, distraction and improving the moment to tolerate painful experiences that she is not able to make better right
away. Interpersonal effectiveness focuses on effective communication skills which emphasize respect for self and relationships. Emily has reported that she has had relationship problems in the past and that many of her friendships end poorly. Learning and utilizing interpersonal effectiveness skills going forward, Emily will be able to ask for what she needs from people in her life, while retaining self respect and also keeping the relationship intact. Emily has shared that she has a difficult time asking others for what she needs and many times will just walk away from the relationship rather than work on it. This has not worked well for her because years later she is still thinking about the relationship that was lost. When mindfulness is mastered, Emily will have the ability to focus on one thing at a time and slow down. DBT states that everyone has three minds; wise, reasonable and emotional mind. When practicing mindfulness you are using wise mind. In wise mind Emily will be able to see the whole situation clearly and will be at peace with decisions that she makes. Previously, Emily has been in emotional mind and bases many of her decisions on emotions. Finally emotion regulation will enable Emily to take care of herself and her emotions. The goal of emotion regulation is to understand the emotions that you are feeling, reduce negative emotions while increasing positive emotions and letting go of painful emotions. This particular concept will be specifically important for Emily and her recovery. Emily ruminates about her best friend from high school and holds on to the trauma of her friend ending the friendship. Emily has stated that she has had thoughts of physically hurting this friend and wanting the friend’s family to hurt as well. She wants the friend to hurt just as much as she does. If Emily is able to let these painful emotions go, she may be able to start focusing on her future and not the past. FIND AN Article TO SUPPORT THIS. Emily may benefit from the group setting when she realizes that she is not alone in feeling depressed. Currently, her inner circle of supports does not understand how she feels or are not willing to discuss their battles with depression. A potential barrier to Emily’s intervention plan is Emily herself. There are days when Emily seems motivated to help herself and then there are days when she does not attend group and wanders in the hallways. I have noticed that Emily has attached herself to another patient and follows him around. Emily has shared with me that being depressed is what she knows and it is comfortable. I am worried that Emily is not one hundred percent vested in the process. I address these issues with Emily during our daily meetings; I have explained to her this program is voluntary and she will only get from it what she wants to. I have told her she is the only one who can put in the work and make the changes she desires. Ultimately, it will come down to Emily. Progress towards Emily’s goals will rely on self reporting from Emily. Every morning we start with a check in where Emily can report symptoms and severity. At the end of the day, Emily will be required to fill out a wrap up sheet for the day which will include skills that she has learned from group and how she will apply them for that evening. I can utilize these two forms to gauge what Emily is learning in group, how she plans to make use of the skills and if it is affecting her symptoms the following day. I will also utilize what she shares with me during our daily meetings.
At the end of the previous school year, Carol, and her daughter’s teachers noticed that Carol’s daughter was not progressing in her studies, and an evaluation conducted by the child study team revealed that she had a specific learning disability. An IEP meeting was scheduled, and conducted. The determination was made to place Carol’s daughter in the same resource room as Carol’s client Jody, for half of the day. Carol instantly realized that this decision put her in a predicament where a dual relationship would be created. She would then cross a clear boundary, and become a parent of a classmate, as well as the professional she has already established herself as to Jody and her parents. This would undoubtedly lead to instances in which both her client, and the client’s family would be interacting with her at both school functions and on class trips. She knew that allowing this to happen was against the BACB Guidelines for Responsible Conduct for Behavior Analysts. Carol voiced her opposition and explained the ethical quandary to those attending the IEP meeting, and what would occur if her daughter was placed in the same room with her client. Carol stated that she would speak with her supervisor, but it was probable that he would determine that she would not be able to continue working with Jody. Carol felt that having to become accustomed to another behavior analyst
DBT is effective when working with clients experiencing anxiety disorder and depression. Individuals in DBT therapy are taught to notice, rather than react to thoughts and behaviors. DBT teaches clients to accept their emotional reactions and learn to tolerate distress while being mindful of their present experiences. DBT has four stages for therapy. In stage one the pre-commitment stage is where the therapist explains what types of treatment the client will receive. In this stage the client must agree to stop all self harm behavior and work toward developing other coping skills. In stage two the goal is to assist the client into controlling her emotions. Stage three and four involve assisting the client to gain the ability to develop self respect (Waltz, 2003).
Psychotherapy integration is best explained as an attempt to look beyond and across the dimensions of a single therapy approach, to examine what one can learn from other perspectives, and how one’s client’s can benefit from various ways of administering therapy (Corey, 2013). Research has shown that a variety of treatments are equally effective when administered by therapist who believe in them and client’s that accept them (Corey, 2013). Therefore, one of the best aspects of utilizing an integrative approach is that, in most cases, if a therapist understands how and when to incorporate therapeutic interventions, they usually can’t go wrong. While integrating different approaches can be beneficial for the client, it is also important for the
Although I was not new in the field of mental health, my work with Susan brought excitement and insecurities. An extreme hoarding case was completely new to me. Even more challenging was, that Susan mental illness and past trauma affected her daily. The use of supervision serves three functions: its educational, supportive, and administrative (Supervision and Clinical Social Work, 2003). I was grateful to have a well-educated, patient supervisor who gave me constructive criticisms as well as support which encourage my growth and development as therapeutic case worker.
As now it can be concluded that to make a supervision session effective it is essential to have a deep understanding of these facts and theories. Characteristics of both supervisor and supervisee are equally important. As supervisors must know their roles and responsibilities at the same time, supervisee should have interest towards reflective practice. Maintaining a good supervisory relationship will be useful to analyse the problems. If there are any signs of underperformance seen in the supervisee, the supervisor can approach them to sort out the matter before it causes
The developmental model, summarized in an article by Stoltenberg (2005), summarizes a supervision approach that uses developmental framework in clinical supervision. The author, Stolenberg (2005) and Ursula Delworth created a developmental model titled Integrated Developmental Model of supervision (IDM). IDM provided specific details about the changes in the supervisee throughout their time in clinical supervision. It also provided specific details on the types of supervision environments and supervisor intervention for each level of development (Stoltenberg, 2005).
...r me to express how I am doing. The best way to utilize supervision is to know how to debrief effectively. Knowing what is triggering, what is stressful, and if the coping techniques are working, are important things to discuss during supervision. Utilizing colleagues within the agency is also a great support system. Even if you are not able to discuss the case, coworkers can still understand and help debrief feelings related to a case.
Dialectical Behavior Therapy (DBT) is a comprehensive cognitive-behavioral treatment developed by Marsha M. Linehan for the treatment of complex, difficult-to-treat mental disorders. Originally, DBT was developed to treat individuals diagnosed with borderline personality disorder (BPD; Carson-Wong, Rizvi, & Steffel, 2013; Scheel, 2000). However, DBT has evolved into a treatment for multi-disordered individuals with BPD. In addition, DBT has been adapted for the treatment of other behavioral disorders involving emotional dysregulation, for example, substance abuse, binge eating, and for settings, such as inpatient and partial hospitalization. Dimeff and Linehan (2001) described five functions involved in comprehensive DBT treatment. The first function DBT serves is enhancing behavioral capabilities. Secondly, it improves motivation to change by modifying inhibitions and reinforcement. Third, it assures that new capabilities can be generalize to the natural environment. Fourth, DBT structures the treatment environment in the ways essential to support client and therapist capabilities. Finally, DBT enhances therapist capabilities and motivation to treat clients effectively. In standard DBT, these functions are divided into modes for treatment (Dimeff & Linehan, Dialectical behavior therapy in a nutshell, 2001).
“Cognitive-behavior therapy refers to those approaches inspired by the work of Albert Ellis (1962) and Aaron Beck (1976) that emphasize the need for attitude change to promote and maintain behavior modification” (Nichols, 2013, p.185). A fictitious case study will next be presented in order to describe ways in which cognitive behavioral therapy can be used to treat the family members given their presenting problems.
I experienced a situation in my practicum where I realized I knew a patient when I entered her room, but didn’t recognize her name beforehand. I informed her of our acquaintance and asked if she would prefer to be visited by another social worker. The patient told me it was alright for me to visit her. Since our relationship had been as acquaintances, and the issues I needed to discuss weren’t extremely sensitive, I was able to fulfill my agency’s responsibilities and intern
These types encompass Cognitive Therapy, Rational Emotive Behavior Therapy (REBT), and Multimodal Therapy. For instance, an individual anguish from a quiet confidence that activates negative thoughts about his or her capacity or display. As a result of these patterns of negative thinking, the person might start averting social issues or passing up opportunities for advancement (Wedding & Corsini, 2014). Cognitive behavior therapy frequently adapted for clients who are comfortable with contemplation. For CBT to be efficient, the Client must be eager to evaluate his or her logic and feelings. Such rumination may be difficult, but it is an excellent way to acquire how internal states impact outward behavior. Cognitive behavior therapy is also appropriate for people looking for an interim alternative treatment that does not inevitably contain pharmacological medication. One of the assets of CBT that aid clients was developing coping strategies that may be beneficial both now and in the
Hi April, I like your post. Micromanagement is what we see in some leaders. I think you did the right thing by letting her know her weaknesses. Going away was not the solution because we are not helping our patients. Letting her know makes her to evaluate herself and becomes stronger person. Remember, we did not know it all at once, people led us to the position that we can now stand a say yes in most instances. Some people might take it easy some might not but it is better to do it in a polite way with the person instead of avoiding the floor and not being our patient advocate.
From my little experience in the field of social work, I go to understand that giving care is an emotionally demanding work. Supervision is very important in helping social workers work effectively and efficiently. Supervision has been an integral part of any organization. One of the importance of supervision is reflecting on and learning from practice, professional development
Being at the apex of the chain of command, the administrative nursing supervisor has numerous responsibilities including but never limited to staffing, conflict resolution, and or crisis. In many circumstances, an administrative nursing supervisor must make timely, prioritizing decisions based on the resources available at any given time. The ultimate outcome ideally is patient and staff safety, and positive patient experiences and outcomes. Throughout the different departments in the facility, there are several governing unions with guidelines and contractual requirements. The facility also has policies and procedures that must be adhered to. Katie remains updated on all guidelines by attending conferences, in-services and administrative meetings. Eason, (2010) stated that, “lifelong learning allows nurses to develop confidence and skill in service provision that is evident to patients, their families, and other health care practitioners” (p.157). I believe that Katie is proficient, has strong leadership skills and is capable of unraveling conflict while following
I believe my supervisor does a good job in showing and saying to these clients that he isn’t there to be their buddy and he can tell when they are telling what they think he wants to hear. Social work is about empowering clients and showing