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September 10, 2012

Summer Reflections

Through my fieldwork at ACT, I have been able to observe how the power dynamic between client and helper affects the client’s recovery. I have also been able to do my own research about power to learn more about power dynamics and the best ways to work with clients. One of the best evidence-based practices for improving relationships between case workers and clients during home visits is for the social worker to act as a guest and allow the client to act as the host (Muir-Cochrane 2000). By acting as a guest, the social worker relinquishes power and gives it to the client, creating a more balanced relationship. This can be especially helpful for clients who have an alternative treatment order (ATO), and do not want treatment, and who find having a social worker at their home to be invasive. In a study of nurses who conducted home visits, Muir-Cochrane (2000) found that acting as guest in a client’s home made a profound impact on the client’s mental health because it shifted the power dynamic and empowered the client. The client felt that s/he had control over his/her home and life. However, acting as a guest also involves sitting down when invited to by the client. Similarly, clients could choose not to ask workers to sit down, and by having control over this decision, there was a more evenly balanced power dynamic between the worker and client. Other research has also discussed the importance of being at the same eye level as a client. Lawrence-Weiss (2010) has found that regardless of the client’s age, one of the most effective ways to assist a client in building self-esteem is to speak to them at eye level. Lawrence-Weiss suggests that if a client stands, then stand; if a client sits, then sit, kneel, or bend over because this allows a client to feel validated. Furthermore, speaking to a client when not at eye level can induce frustration at not being truly heard or understood. It creates an unbalanced power relationship in which the social worker is superior to the client.

I truly appreciate the feedback that my team leader, supervisor, and team provide to me. Although I am completely comfortable at my field placement and feel well trained, I still have much to learn. I often find myself asking for feedback about how I handled different situations, so I can continue to improve my skills.

Due to the classes that I am taking, I have been provided with many opportunities to integrate my class work, research, evidence-based knowledge, and field experiences. On the first day of class, I look through all of the assignments and find ways to connect the assignments to field, so that I can do more investigative research that will be meaningful to my field placement. Integrating my learning is important to me because I find that I remember it for longer and have a deeper connection to it. It is a more authentic type of learning. This semester, I was able to take a course about group work and then apply the concepts from class and research to the groups that I lead at CSTS. In Mental Health Practice, I was able to learn better ways to write progress notes, assessments, and individual plans of service (IPOS), which I have also utilized at field.

When I first started at the University of Michigan: School of Social Work, I had clear goals in mind. My primary goal was to help improve the lives of others and lessen the suffering of oppressed populations. A second goal was to secure an internship at an inpatient or intensive outpatient setting. As for learning, I hoped to learn to provide effective psychological treatment, to diagnose mental illness based on the criteria in the DSM IV-TR, to evaluate patients and write discharge plans, to provide individual, group, and family therapy, and to record notes on patients and patient progress. I am proud to say that I have already accomplished many of these goals at my field placement. I was able to secure at internship working with serious and persistent mental illness clients who have acute and chronic mental illness. I have learned in classes and field about evidence-based practices, like Assertive Community Treatment, and other treatment modalities (CBT, DBT, and Motivational Interviewing) which I utilize daily. While I have taken courses pertaining to diagnosis, the social workers at ACT do not have the role of diagnosing clients, but I am pleased to have learned the skills necessary to perform this role. I evaluate clients daily through Mental Status Exams, and write progress notes for every client that I see. I have not been involved in transfers (discharges), but I hope to be more involved next semester.

Posted by desolada at September 10, 2012 08:22 PM


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