Every week I meet with my peers in group supervision and talk about cases along with our supervisor. But meeting with an entirely new group of individuals and perspectives gave me a fresh viewpoint on how I could better help my client. Critical thinking of my group was and is greatly appreciated for furthering the effectiveness of my interventions.
The client I discussed is approximately thirty years of age and female. She used to work in the financial sector but eighteen months ago stopped working because she reports no longer feeling able to handle the stress of the job. She had been seeing a psychiatrist and upon some negative reactions to medications she was taking, was taken off all medications in three days which caused further reactions and sent her to the hospital. Her parents recommend that she take medication as they see it as the only intervention that will "fix her" (their words). The client is against taking medication again as a result of the negative consequences she experienced in the past and has sought other forms of intervention including seeing two social workers (myself included) and a nutritionist.
My sticking point in this case, my challenge, revolves around knowing how hard to push on her. She has made significant progress in the past four months that we have been working together including a move from not being comfortable applying for a job at the library because she did not feel that she would be able to handle the pressure of working on a daily basis nor the perceived requirement of wearing jeans to work due to a chronic health problem to the point where she is now working twenty four hours per week through four, six hour days doing financial work for someone she used to know. This is an excellent illustration of one of her negative recurring cognitions, she sees not the progress (unless prompted) but instead, only that she is not working full time.
The client recognizes the things she is doing that are improvements over how she was before she started seeing me but clings to the secondary benefits of being "sick" as she coins it which include increased interaction with her parents and attention with decreased responsibility. Throughout her childhood she spent time under critical parents who were always after her for the one question she missed on a test and not the forty-nine that she was correct on. Through various interventions I believe I have helped and with conversation she can recognize the progress but her automatic response is to cut down what she has done.
The group suggested that we better assess what her goals are for treatment so that we can more accurately gear our interventions to address them. They suggested that the change in her reflex thoughts to the events of her life is important as I had been talking about but thought that it would be important for her to recognize the slow gains of treatment while we work to have her see things from different perspectives such as asking her what she thinks her roommate might think of what she has done. Further the group pointed out that it is critical to work to see things from her perspective in order to better address her concerns.
As an interesting addition, I saw the client after class today and upon asking her what her goals are and whether or not she thinks she has made progress, the client reported that she thinks she isn't really getting anywhere. When I asked about how she explains some of the gains she has made in working and socially where she was very limited in interaction before she explains them away with circumstance until I push on her at which point she reluctantly takes credit for them. But the switch to her taking credit for them has become more rapid. She is certainly making progress and my being a bit more firm now that we have such solid rapport seems appropriate and effective.
Now that I'm writing the blog I feel it is difficult to capture the problem as I described it to the group during class. I hope that I made my way around to it. The group was incredibly helpful in their thoughtfulness when listening to what I was saying and offering their advice. Thanks folks!
I think that the changes she has made as evidenced by something like the change in her ability to work shows that you have been doing really good work, Will. I wonder if analogies work with this client? Perhaps after assessing the feasibility of her treatment goals, you can help by comparing the slow, uphill journey that is mental health to something that is relevant to an interest of hers. Maybe she did something as a child that took a long time and was very grueling during the process, but was very, very rewarding at the end. I am sure that you have probably done something like this, but in the oft chance that you have not, it might assist in giving her some realistic perspective on how long-term treatment normally works. Hope this helps.
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