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DSC8883 - SECTION 2: CASE EXAMPLES

 

This section will present eight case examples involving the use and misuse of self-disclosure. Please read them and consider them in light of the following questions: Is the disclosure in the interest of the client? Is it germane to what the client is currently expressing? Are the content, timing, and intensity of the disclosure appropriate?

To perform a thorough analysis of the self-disclosure issues in each scenario, you should allocate about 5-10 minutes per scenario.

Later in the course we will return to these scenarios in order to present some more detailed analysis. If you wish, you may print each scenario so that you may have them to refer to as new material is presented.



CASE I

Susan Brown is a medical social worker in a large suburban hospital. Her client, Mrs. Morgan, is a middle-aged woman whose husband is dying of cancer. Behind the closed door of Susan’s office, Mrs. Morgan tearfully tells Susan of her struggle to remain hopeful for her husband and family in the face of Mr. Morgan’s obviously deteriorating condition. Mrs. Morgan is ready to realistically face the inevitable loss of her husband but feels the family is not ready and would be shocked and angry at her suggestion that they prepare for his death. During this emotional dialogue, the office door opens and Susan’s social work supervisor, Mrs. Rushing, enters without knocking. The supervisor recognizes Mrs. Morgan and sees her tear stained face and pained expression. Being familiar with the client’s circumstances, the supervisor acknowledges that the client is discussing her husband.

Mrs. Rushing then begins to talk of her own reaction to her father’s death, stating that she could still feel the emotional pain ten years after the fact. She talks on for several minutes becoming very emotional and tearful and finally leaving. Susan then turns to the client who makes no comment about the interruption and resumes where she left off. Later Mrs. Rushing tells Susan that this kind of self-disclosure is helpful to get the client’s mind off the problem and to let them know that others have experienced the same thing.

Questions:

Is the disclosure in the interest of the client?
Is it germane to what the client is currently expressing?
Are the content, timing, and intensity of the disclosure appropriate?



CASE II

Jill Brooks is a social worker in a middle school. She began a group counseling program that meets during students’ lunch time in her office. Topics include a broad range of issues important to the 12 and 13 year olds with whom she works. Initially these groups became popular with the students because it was a way to get out of the supervised lunch room and have lunch with your friends in a less structured atmosphere. At first the groups attracted only girls and some of the “less than cool” boys. However, at one point six of the male "jocks" in the school approached Jill about forming a group. Although Jill knew their motivation was to get out of the lunch room, she began meeting with the boys on a weekly basis. After some difficulty focusing during the initial group sessions, and once they had confidence that group discussions were confidential, the boys "bought-in" to the activity of discussing the problems of school life with each other. For Jill this was a triumph because it demonstrated that social work programs were for everyone, not just the discipline and academic problem children in the school.

One day, the boys really let their hair down with each other and began to talk about times when other kids had teased them about some physical characteristic and how bad this made them feel. Each boy shared the anguish of being called "shorty", or "geek", or "four-eyes", or about having been teased because their pants were too long or too short, or their shirt wasn't "cool". During one moment of silence, one of the boys asked Jill if she had ever had this experience. Jill thought for a moment about how personally invested she was in this group, and how the group had enhanced her professional status in the school. So, in a matter-of-time tone she replied, “When I was 13 my best friend used to call me "F. F." which was short for "Fat, flat". Before anyone could react, the bell rang and it was time to go to class.

As Jill reflected on the group process that had just occurred an uneasy feeling came over her, but she could not identify its source. Throughout the afternoon, as students would periodically change classes, Jill would see members of the boys’ group. She immediately noticed that as they passed by her they exchanged looks and laughter. By the next day, the laughter was louder. By the third day, they were waving at Jill and blatantly shouting, “Hi ‘F. F’!"

Questions:

Is the disclosure in the interest of the clients?
Is it germane to what the client is currently expressing?
Are the content, timing, and intensity of the disclosure appropriate?


CASE III

Roger White is a licensed therapist who is establishing a private practice. He recently received a referral from a colleague. The client, Mrs. Hopkins, arrives for her first appointment with Roger. She is a 40 year old homemaker, married for 20 years to the same man. Her children are 17 and 15 years old. She describes her symptoms that include weeping for no apparent reason, anxiety, sleep disturbance, and irrational fears while driving, riding in elevators, or flying. These symptoms began three months ago and have persisted. Mrs. Hopkins recently underwent a physical exam and was found to be in good health. After relating her symptoms Mrs. Hopkins states, “I suppose I sound silly and maybe all this is just in my head. I don’t know why I feel this way when I’ve never experienced anything like this before. It is awful to spend every day like this. Do you think you can help me?” Roger responds emphatically, “Of course. My wife recently went through the same thing. It was as awful as you describe. We just didn’t know what to do for her and it affected the whole family. We thought she’d never be herself again."

Roger continues, "My wife spent hours just lying in bed. She neglected all the household chores so we ordered pizza and my daughter did the laundry. We came close to divorce and the kids spent as much time away from home as they could. I can tell you the family almost came apart at the seams. My wife finally pulled herself together and began to function. I can tell you I was greatly relieved. So you see I believe I can help you.” For the remainder of the session Roger offers information about his professional background, insurance reimbursement, and policy on missed appointments while Mrs. Hopkins sits quietly. He offers to schedule a follow-up appointment and Mrs. Hopkins states that she isn’t certain of her schedule and will have to call him.

Questions:

Is the disclosure in the interest of the client?
Is it germane to what the client is currently expressing?
Are the content, timing, and intensity of the disclosure appropriate?

 

CASE IV

Jim Smith is a licensed clinical social worker and a certified addiction counselor at a county mental health facility. For the past three months he has conducted twice-weekly psycho-educational groups for adults with alcohol and drug abuse problems. The clients are between the ages of 18 to 45. About one-third of them are voluntary, one-third were recommended to attend by DFACS, and the remaining third were ordered to attend by the courts. Jim has worked hard to make the group successful. He reviewed the current literature on substance abuse and group treatment, the skills needed for group leadership, and group process. He attended group sessions held by colleagues in other agencies. He recalled previous experiences leading groups and identified what was successful and what was not. In the three months since he took over the group, attendance has increased from an average of eight to the maximum number of fifteen. He knows that he has the group’s trust and confidence and that he is perceived as capable and competent. Group members have indicated that they feel he understands their struggle.

Group sessions always begin with a check-in where each group member states their name, drug of choice, and pertinent information about their struggle. On one particular night as check-in ends, a member says to Jim, “We know what our drugs of choice are, but what is yours?” Jim has never had an addiction to alcohol or to any illegal substance. He has, however, struggled to deal with overeating and smoking since he was a teen-ager. He believes that dealing with his own addictions have allowed him to understand the experience of his clients. He also knows there is substantial literature indicating that substance abusers relate well to group leaders who are recovering addicts. He is concerned that he will lose the respect of the group if he tells them the truth.

Questions:

Is the disclosure in the interest of the clients?
Is it germane to what the client is currently expressing?
Are the content, timing, and intensity of the disclosure appropriate?



CASE V

Linda Stone, a social worker in her late 20’s, was working with a 50-year-old client, Mrs. Bell, who was trying to cope with profound depression due to the sudden and untimely death of her husband. During the first two sessions, Linda sat quietly while Mrs. Bell talked about her husband, his death, and the emotional pain she was experiencing. She cried throughout these sessions. At the end of each session Linda would indicate that time was up and she would see Mrs. Bell the next week. At the third session Mrs. Bell became angry and stated that the therapist was too young to understand. Linda responded by asking, “Do you think no one really understands what you’re going through? The client than began to talk about how alone she felt. Later, in that same session, Mrs. Bell again made reference to Linda’s apparent youth and not understanding what she was going through since Linda was too young to have experienced deep loss.

Linda responded by saying, “Why do you think that although I am younger than you, I have not experienced great loss? My father died when I was only 12 years old. While that’s not exactly the same as losing a husband, I do relate to the depth of your feelings. I know what it is like to feel intense pain and wonder if you will always feel like this.”

Questions:

Is the disclosure in the interest of the client?
Is it germane to what the client is currently expressing?
Are the content, timing, and intensity of the disclosure appropriate?

 

CASE VI

Gerald Taylor is a licensed clinical social worker in private practice. For the past year and a half, he has been addressing an illness to his 10-year-old daughter that has created significant disruptions to his schedule and has caused him on more than one occasion to be pre-occupied with the well-being of his loved one. He has been very selective about addressing this issue with his clients, as he does not wish to place clients in the position of providing support to him during the periodic medical flare-ups. He has been noting with clients when a "family emergency" is responsible for needing to cancel appointments at the last minute. However, a number of his clients have pressed him for more specific information about why he needs to reschedule his appointments so frequently, a couple of them even asking if he is okay when he comes into a session with a particular heaviness about him.

One of his clients is a nurse at one of the local children's hospitals. Although it has never been addressed in the sessions, Gerald is aware that she may have had access to medical information about his daughter during her stay at that hospital on one occasion. He is concerned because the presenting issues for this client have to do with a history of co-dependence and over-responsible caretaking behaviors on the part of this client. Gerald is concerned that his client is withholding her acknowledgement of the medical issues of his daughter in an attempt to be protective of Gerald within the relationship. Worried about this component of their relationship, Gerald elects to provide some additional information about the nature of his family emergencies, while noting that his client may work at a position where she has some awareness of this part of his personal life. He then goes on to ask the client if she knew of his daughter' condition, and if it would be helpful to discuss the implications for the therapeutic relationship. 

Questions:

Is the disclosure in the interest of the clients?
Is it germane to what the client is currently expressing?
Are the content, timing, and intensity of the disclosure appropriate?

 

CASE VII

Patricia Flynt is a licensed social worker currently working as a supervisor at a small, publicly funded mental health center in a suburban location. Many of the treatment sessions are conducted by newer clinicians who are not yet licensed at the independent level, with Patricia serving as the clinician of record. As part of her training approach, she will occasionally sit in on a session to be able to see more clearly where her supervisees are in terms of their skill development. This set-up is explained very clearly to the clients when they first come in for treatment and is reinforced each time that Patricia attends one of the sessions. 

One of her less successful supervisees, Jim, has been struggling with several of his substance abuse clients lately, and Patricia has decided to work a little more closely with him and sit in on sessions more frequently to get a better picture of where his work is falling short and what additional education, guidance and support might help his performance improve. James became a social worker later in his life after he overcame a long-standing problem with alcohol abuse, and he has been sober for over 5 years.

The first session of the day for Jim is a 32 year-old female who is trying to overcome an addiction to methamphetamines. Jim is providing ongoing relapse prevention work for her, with a detailed relapse prevention plan, but the client has been unable to maintain sobriety for more than a week or two at a time. She has been presenting as increasingly discouraged and has been making vague suggestions that she is ready to give up and wishes that she didn't have to deal with this anymore, which has led to increased worry about suicide on the part of Jim. In the course of the session, Patricia can see the level of anxiety rise in Jim, and she can see Jim move away from using the structure of the relapse prevention plan and the techniques of Motivational Interviewing as primary approaches. 

Patricia is aware that Jim has shared with all of his patients his own experience and his own journey through recovery. She is also concerned that Jim's worries about his client may also be connected to potential threats to his own recovery posed by his difficulties in making progress with his clients of late. She decides to suggest to Jim that he spend a little time talking with his client about some of the dark places that he found himself during his own recovery and some of the things that he found helpful as he worked his way gradually towards a point of sobriety, including some of the Motivational Interviewing approaches that were used by his clinicians to develop and strengthen his own motivation for staying with the program. 

As Jim begins to go into some of the details of his own journey of recovery, and some of the things that he found helpful, Patricia sees him start to relax a little bit and bring his therapeutic skills back into the treatment with his client. While there is not an immediate improvement in the client's state of mind with regards to her own recovery, Patricia believes that Jim may be better prepared to stay on track with using the correct techniques within his work.   

Questions:

Is the disclosure in the interest of the client?
Is it germane to what the client is currently expressing?
Are the content, timing, and intensity of the disclosure appropriate?

 

CASE VIII

Marsha Vega is a licensed professional counselor who works in a small, publicly funded agency in a small town and specializes in child and family concerns. She has a son who struggles with Tourette's Disorder, and who has been having difficulties at school with verbal outbursts in class. While Marsha has provided extensive consultation to the school about her son, and helped the school personnel to understand and respond to the disorder in optimally effective ways, her son has had a difficult time making and keeping friends, as the children in this school view him as "weird".

One of Marsha's tasks in her agency is to run a group to expand the knowledge and skills related to parenting. Because she lives and works in the same small town, many of the people in the group have children who attend the same school as her son. Accordingly, whenever any new parent comes into the group, she provides some information about her son and his condition, using that time to provide some education about Tourette's and other disorders affecting children, and the impact on the kind of parenting skills that are required to address those kinds of problems successfully. 

During one of these introductory speeches, one of the newest group members blurts out something about Marsha being the mother of that "weirdo" who curses her daughter out at school. Marsha uses this as an opportunity to discuss in more detail the signs and symptoms of Tourette's disorder, the neurological basis of the disorder, and some of the challenges of working with special needs in children, including the social challenges and the parenting issues related to protecting the self-esteem of children who suffer from these kinds of special needs.

While Marsha works very hard to maintain her emotional composure while providing this information, one of the members of the group asks her in a very supportive way if she is doing okay. Marsha provides reassurance in this regard, but realizes that she is beginning to tear up in spite of her best efforts. One of the group members offers her a tissue and Marsha thanks her then tries to move on to refocus on the concerns of the group. 

Questions: 

Is the disclosure in the interest of the clients?
Is it germane to what the group is going to be addressing?
Are the content, timing, and intensity of the disclosure appropriate?

 

CASE VII

Marsha Vega is a licensed professional counselor who works in a small, publicly funded agency in a small town and specializes in child and family concerns. She has a son who struggles with Tourette's Disorder, and who has been having difficulties at school with verbal outbursts in class. While Marsha has provided extensive consultation to the school about her son, and helped the school personnel to understand and respond to the disorder in optimally effective ways, her son has had a difficult time making and keeping friends, as the children in this school view him as "weird".

One of Marsha's tasks in her agency is to run a group to expand the knowledge and skills related to parenting. While the group provides a good deal of emotional support to all the parents and may, at times, engage in some actions that resemble group therapy, the larger focus of the group is on developing parenting skills. Marsha is quite skilled at bringing the focus of the group back to the primary focus and preventing the group from becoming in-depth therapy. That said, there have been occasions where the flow of the meeting required that some therapeutic work be done with group members who needed that additional level of support. As a follow-up to those instances, the parents were offered the option of family therapy.

Because she lives and works in the same small town, many of the people in the group have children who attend the same school as her son. Accordingly, whenever any new parent comes into the group, she provides some information about her son and his condition, using that time to provide some education about Tourette's and other disorders affecting children, and the impact on the kind of parenting skills that are required to address those kinds of problems successfully. 

During one of these introductory speeches, one of the newest group members blurts out something about Marsha being the mother of that "weirdo" who curses her daughter out at school. Marsha uses this as an opportunity to discuss in more detail the signs and symptoms of Tourette's disorder, the neurological basis of the disorder, and some of the challenges of working with special needs in children, including the social challenges and the parenting issues related to protecting the self-esteem of children who suffer from these kinds of special needs.

While Marsha works very hard to maintain her emotional composure while providing this information, one of the members of the group asks her in a very supportive way if she is doing okay. Marsha provides reassurance in this regard, but realizes that she is beginning to tear up in spite of her best efforts. One of the group members offers her a tissue and Marsha thanks her then tries to move forward to refocus on the concerns of the group. 

Questions: 

Is the disclosure in the interest of the clients?
Is it germane to what the group is going to be addressing?
Are the content, timing, and intensity of the disclosure appropriate?

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