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DSC8883 - SECTION 2: CASE EXAMPLES

 

This section will present five 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?

 

 

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