Therapeutic Foster Care: Becky's Story

Becky’s Story
This is the story of Becky, an 11 year old, African American, female client who has been placed in Therapeutic Foster Care. Becky describes her traumatic experience of losing her parents in a bad, bad storm. Becky’s verbal account of how her parents died is a wild fantasized story and inaccurate. She uses the word ‘bitch’ regularly, has frequent night terrors, acts out aggressively toward foster siblings, lies, is experiencing night terrors, and is excessively attached to her foster father and case worker named Emily. Becky has explained that sometimes she freezes which is an emotional and physiological response to the trauma she has experienced.
Emily, Becky’s case worker, is an experienced worker but is having some personal

difficulties working with this case and Becky. Emily states she cannot sleep due to thinking excessively about this case, has reported feelings of anxiety when anytime Becky’s case is mentioned, has reported to co-workers that some of her days she has missed work is due to the scheduling difficulties working with Becky. Emily is also excessively indulging Becky but has admitted this behavior is not appropriate and that she feels horrible when thinking of not helping Becky in this manner. Additionally, Emily is afraid that the prospective adoptive parents will not want Becky due to her emotional problems and challenging behavior(s).
Who is traumatized in this case and how?

One person being traumatized in this case is the child client, Becky. Becky’s interests are not being served by her case worker in a professional manner. The worker is obsessed with Becky to the degree that she spends more time than is needed with Becky in that she visits Becky when she calls with a crisis on an average of 3 to 4 times per week. The duration of these visits is extensive.
Becky is a trauma survivor. Van Der Kolk (1991) reintegrates Kardiner’s five principal features of PTSD which list: (1) persistence of startle response and irritability, (2) proclivity to explosive outbursts of aggression, (3) fixation on the trauma, (4) constriction of the general level of personality functioning, and (5) atypical dream life, (para. 4). These trauma tenets are readily visible in Becky’s challenging behavior(s) and fantasized cognitive expression of how her parents

died.
According to Merriam-Webster (n.

d.) co-dependency is a psychological condition in which someone is in an unhappy and unhealthy relationship that involves living with and providing care for another person (such as a drug addict or an alcoholic). But this condition can be applied to any person who is heavily involved with another person such as a case worker to their client. Co-dependency is a disproportionate psychological/emotional reliance on another person who requires support due to any type of illness. It can be described as a relationship addiction. Co-dependent people have a greater tendency to enter into relationships with people who are emotionally unavailable or needy, (Psychologist Anywhere Anytime, n. d.). Self emotional sabotage is the result. At first appearance, Emily is engaging in a co-dependent relationship with her client,

Becky.
However, a more deductive appraisal of Emily’s case work issues can be explained as countertransference. In a therapeutic relationship, redirection of either the client or the worker’s feeling toward each other can occur. There are times when clients’ or workers’ feelings are projected onto each other in the relationship. This is called transference. Transference is directly applied to the client while countertransference can be specifically a worker issue. Countertransference is the complex of feelings of a psychotherapist toward the patient, (Merriam-Webster, n. d.).
Seasoned case workers should have the ability to use self-evaluation. In this case, it happens to be the worker who is experiencing countertransference. This type of relationship is detrimental to any client because the worker is not remaining neutral. Emily is clearly taking this relationship too far and acting as if she were Becky’s caregiver and not her case worker. Emily has lost her objectiveness where Becky is concerned.
Foster parents play a significant role caring for children in state custody. By avoiding the foster parents concerns and wishes, Emily has also forgotten that she has more than one client in this case. The foster parents are also her clients and they are an essential part of Becky’s support system. Becky’s foster parents are with Becky on a daily basis and are more qualified to know what Becky’s needs and problems are. Emily is not implementing trauma-informed intervention(s) in that she is not following trauma-informed care principles by Steele (2012) in his book, Trauma-informed Practices with Children and Adolescents and outlined as 1. Understanding Trauma and its Impact, 2. Promoting Safety, 2. Ensuring Cultural Competence, 4. Supporting Consumer Control, Choice, and Autonomy, 5. Sharing Power and Governance, and 6. Integrating Care. Emily is violating NASW Code of Ethics (2008), specifically, the ethical principles of service, integrity, self-determination, informed consent, cultural competence/social diversity, conflicts of interest, physical contact, supervision and consultation, private conduct, impairment, and integrity of the profession.
How is Emily being trauma informed?
Steele (2012) states healing happens in relationships: believing that establishing safe, authentic, and positive relationships can be corrective and restorative to survivors of trauma; and recovery is possible: understanding that recovery is possible for everyone, regardless of how vulnerable they may appear. Providing opportunities for consumer and former consumer involvement at all levels of the system, facilitating peer support, focusing on strength and resiliency, and establishing future-oriented goals, (p. 17). The worker in this case is approaching this client’s intervention(s) from a trauma-informed framework by believing this client can recover, establishing rapport with the child client, and providing a consistency in the Becky’s life. Emily is a worker who recognizes the importance of human relationships and how they can be an avenue for change.
The worker is providing a consistent relationship with Becky which will foster change in Becky. Becky has the need for safety, belonging, to be loved, and to experience feelings of trust. A consistent worker/client relationship can be the element in a client’s life that is missing. When this type of relationship is applied, the healing process is accelerated. 1981 is the mark for the Jean Miller’s Stone Center Group and her feminist relational-cultural theory or Stone Center Group theory. Miller wrote her theory Klein based theory in 1976. Miller’s theory is grounded in interpersonal mutuality. Comstock states:
Core RCT tenets that explicate the process of psychological growth and relational development, as summarized by Jordan (2000), include the following notions:
1. People grow through and toward relationship throughout the life span.
2. Movement toward mutuality rather than separation characterizes mature functioning.
3. The ability to participate in increasingly complex and diversified relational networks characterizes psychological growth.
4. Mutual empathy and mutual empowerment are at the core of growth-fostering relationships.
5. Authenticity is necessary for real engagement in growth-fostering relationships.
6. When people contribute to the development of growth-fostering relationships, they grow as a result of their participation in such relationships.
7. The goal of development is the realization of increased relational competence over the life span. (Comstock et al., 2008)
As a human being, Becky has the inherent need for positive personal relationship.
How can Emily be more trauma-informed?
Culturally competence interventions involve helping clients draw on cultural strengths to creatively solve life issues and problems. In the development of children, temperament differences are in part due to cultural differences and linked to parent-child interactions which are culturally driven. Emily has overlooked this aspect in her dealings with Becky. According to Steele (2012) trauma-informed care best practices include:
• Ensuring Cultural Competence: Understanding how cultural context influences one’s perception of and response to traumatic events and the recover process, respecting diversity within the program, providing opportunities for consumers to engage in cultural rituals, and using interventions respectful of and specific to cultural backgrounds
• Develop and include interventions that respect and support cultural diversity
• One common factor related to efficacy found across the literature is that when ethnically matched professionals are available, retention and intervention benefits improve over those who receive services from nonethnically matched professionals (Snowden, Hu, & Jerell, 1995)
• All aspects of an environment must be trauma-informed, attending to the developmental and psychosocial needs and cultural values and beliefs of traumatized individuals
Emily should elicit the help of her supervisor to be more trauma-informed. Supervisory input is an essential part of child protection worker’s arsenal of resources. The needs of service providers are also considered within a trauma-informed service approach. Education and support related to vicarious trauma experienced by service providers themselves is a key component, (Canadian Centre of Substance Abuse, 2012).
What are some methods for creating safety for Becky?

What dilemmas are present ethical or not, and how can Emily work thru those?
Emily is breaking the NASW Value: Service Ethical Principle (2008) that states social workers elevate service to others above self-interest.
Emily has a boundary issue and has empathy and sympathy confused. Empathy is the understanding what others are feeling because you can put yourself in the client(s) shoes or you have experienced the same problems or issues yourself. Sympathy is acknowledging another person’s emotional hardships and providing comfort and assurance. NASW states that clients do not need sympathy or sorrow in most cases; they need someone to listen to them, support them, and to validate their emotions in a caring and empathic manner (2005). Sympathy is not part of a professional relationship.
Emily is trapped by her dual relationship with the client. It appears that she is trying to be Becky’s friend instead of her case worker. According to Hatfield (n.d.) dual relationships should be avoided. These occur in situations where the member is both the clinician and also holds a different significant authority or emotional relationship with the same person. And, Peterson (1992) states boundaries are “the limits that allow for a safe connection based on the client’s needs”. Friendship has a more mutual affection component which is not necessary in a helping relationship and do great harm when applied by a worker. With this type of relationship and the breaking of professional boundaries, the worker can do more harm than good. Emily may be imposing more trauma for Becky and her foster parents.
How did this case make you feel?
I felt like this is a typical case example for the client but not for the worker, Emily. Emily may be doing more harm than good in this case. I would question if this is the right job and position for Emily due to the mirroring of her client and adding more stress onto herself in that way. I would want to ask Emily if she paid attention in her social work classes, especially to the part about self care and leaving your work life at work and not in your home life, because she has clearly broken some of the NASW rules, particularly, self evaluation of her social work practice. There are clear social work ethical boundaries that have been broken by Emily. Emily is ignoring the foster parents concern(s) and is agitating the foster parents; she is using sympathy instead of empathy; she is not acting in a professional manner; she is not using the appropriate client/worker relationship; she is falling into the trap of having a dual relationship with the client Becky. Emily will increase her well-being by reducing anxiety and provide an exemplary role model for her clients if she sets appropriate boundaries with her clients.