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HUM9997 - SECTION 2: CASE SCENARIOS

 

Please take some time to read the following scenarios and answer the questions related to the scenarios. Later, we will present scenario analysis that you can compare with your own understanding of the scenario.

SCENARIO ONE

Jeff is a clinical social worker providing services in an outpatient setting. Jeff usually operates from a short-term, but eclectic, therapeutic perspective. He is seeing a young, African-American couple, Wesley and Patricia, for the third session. They are seeking assistance for brief couples counseling. Complicating their relationship dynamics is the fact that they are both medical residents who are living in two different states, in high-stress fields. Reportedly, Wesley called off their wedding due to concerns about individual differences such as Patricia’s passivity. As he stated this more directly, Patricia became more submissive and withdrawn. Later on in the session, with encouragement, Patricia became gradually more communicative. Then, both began to engage in a power struggle over who possessed the superior way of interacting, which they began to morph into who was inherently superior. Despite various subtle and blatant attempts to redirect the session and help the couple take responsibility for their individual roles, their discussion escalated and Jeff’s voice was drowned out by the bickering. Spontaneously, in the midst of this, Jeff blurted out, with a faint smile, “I don’t know why you all are arguing about this. As the counselor, MY WAY of communicating is clearly the best.”


Was this an appropriate application of humor in the session? If so, was it germane to the couple’s reason for seeking therapy? If not, how did you see this as potentially destructive or ineffective?

How would you describe the target of the humor and the greater context it was being used?

Before using this intervention, what mitigating factors (e.g., interpersonal differences) or therapeutic issues (e.g., transference) would you have needed to assess in the client and therapist?

In what ways might you respond to the client’s reaction if the intervention was unsuccessful?

What other interventions might you consider in this situation – with or without the use of humor?


SCENARIO TWO

Cathy recently graduated with her Master’s in Social Work and obtained a position as a medical social worker in the local county hospital’s oncology unit. Part of her job function is to perform psychosocial evaluations, triages, referrals, and short-term counseling for patients while they are hospitalized. Kathy has been asked to begin screening members for a cancer support group, which will be co-led by one of the lead oncology nurse practitioners. Cathy met one of her first clients, John, a young man in his late 30s recently diagnosed with a rapidly spreading brain tumor. John became easily agitated and looked at her stating, “What do YOU want?!” When Cathy gently and thoroughly explained her role, he responded, “I’m not crazy, so why would I need a shrink?” Cathy responded by trying to normalize his sense of frustration and shame, but again, was met with anger. “It's my family that needs counseling; they are the ones that are freaking out over this. Why don’t they go and talk to a darn group?” When Cathy agreed to offer support to the family, John remarked, “I have already accepted that this is the end, I certainly don’t need to be reminded of that by you or anyone else.” Cathy then responded, “Well, if you aren’t interested in working in the group as a patient, how about as a leader, we could certainly use someone who is in the acceptance phase!”

Was this an appropriate application of humor in the session? If so, was it germane to the individual’s reason for seeking therapy? If not, how did you see this as potentially destructive or ineffective?

How would you describe the target of the humor and the greater context it was being used?

Before using this intervention, what mitigating factors (e.g., interpersonal differences) or therapeutic issues (e.g., transference) would you have needed to assess in the client and therapist?

In what ways might you respond to the client’s reaction if the intervention was unsuccessful?

What other interventions might you consider in this situation – with or without the use of humor?


SCENARIO THREE

Carl is a professional counselor, who serves at a lead therapist at a clinic providing brief, system-focused, family therapy. He has been working with a family for 4 sessions and feels he has a solid grasp on some of the dynamics. The family consists of Karen, 47, the mother and wife; Robert, 50, the husband and father; and Skye, 15, the daughter. The family began seeking services after Skye’s school guidance counselor recommended they do so because she was becoming more oppositional and irritable at school during the past several months. The school counselor had a difficult time contacting her parents to discuss the situation. During the session, Robert constantly berated himself for working too much and essentially being unavailable to Skye. Then, Karen would automatically come to his rescue by consoling him – explaining why he had no other choice but to work overtime to afford the lifestyle to which the family had grown accustomed. In the midst of this, Skye would become more withdrawn while rolling her eyes and letting out a noticeable sigh of annoyance. Her parents would fail to notice without Carl directly verbalizing his observations. However, even after doing this and even trying to gently inquire and speculate about Skye’s feelings, she denied any animosity or suppressed emotions, and her parents expressed little curiosity or concern about the origin of or potential for these feelings. At one point in the session, Carl made eye contact with Skye and then at her parents. He picked up his a couple of little foam balls and began to juggle them in the air while Karen and Robert continued to interact exclusively as a dyad. After a minute or so, the parents everyone stopped and began to stare at Carl. Carl stated, “I was wondering how we would get your attention.”


Was this an appropriate application of humor in the session? If so, was it germane to the family’s reason for seeking therapy? If not, how did you see this as potentially destructive or ineffective?

How would you describe the target of the humor and the greater context it was being used?

Before using this intervention, what mitigating factors (e.g., interpersonal differences) or therapeutic issues (e.g., transference) would you have needed to assess in the client and therapist?

In what ways might you respond to the client’s reaction if the intervention was unsuccessful?

What other interventions might you consider in this situation – with or without the use of humor?


SCENARIO FOUR

Jacob is a post-doctorate clinical psychologist working as a group therapist for an adolescent anger management group in an outpatient treatment center. The group is open-ended for males ages 14-17 and the presenting problem revolves around anger-related relationship problems with teachers, students, or parents, related to anger. The format is psycho-educational and therapy process with a solution-focused bent. Jacob has taken the group over after the previous long-time leader retired. A group member, Brian has been diagnosed with depression and oppositional defiant disorder. Per the previous therapist, Brian has made some progress in the group in terms of recognizing how his hostility masked his vulnerability, and using this to adopt a leadership role in the group. Brian was extremely attached to the previous therapist, and was struggling to adapt to the changes. This is evidenced by continued subtle, frustrated statements he vocalized in group comparing the previous and new therapist unfavorably. When Jacob made efforts to attend to these remarks, they were met with sarcasm which began to derail the group from focusing on their presenting problems. On one particular occasion, Jacob had the group begin to brainstorm “ways to cope with the group transition and loss”. The consensus was the group wanting a therapist that more closely resembled the previous therapist in age and style. Even if this was approved by the center, Jacob pointed out the obvious flaw in that idea, being that an older leader would also retire soon, and leave them in a similar predicament. Brian then chimed in by asking how long Jacob would be there given he was not a “real therapist” yet and the group was only his “school project.” Jacob responded by stating in a casual tone, “I will stay here as long as I need to. In fact, I will repeat the year or apply for this position after completing my dissertation. Nothing and I mean NOTHING will keep me from leaving this group!” “What about family emergencies or your own death?” the group asked. Jacob replied “I plan to reincarnate as an older, wiser, immortal therapist so you will never have to worry about a leader leaving you again!”
Was this an appropriate application of humor in the session? If so, how was it germane to the group process? If not, how did you see this as potentially destructive or ineffective?

How would you describe the target of the humor and the greater context it was being used?

Before using this intervention, what mitigating factors (e.g., interpersonal differences) or therapeutic issues (e.g., transference) would you have needed to assess in the client and therapist?

In what ways might you respond to the client’s reaction if the intervention was unsuccessful?

What other interventions might you consider in this situation – with or without the use of humor?


SCENARIO FIVE

Sally is a social worker at a Center for Women doing long-term therapy specializing in women who have been emotionally abused. She has been working with Sam, a 26 year-old, Single, Caucasian, female nearly a year using a traditional psychodynamic approach. Her reason for seeking therapy is to learn how to attract men that will treat her better. One of the ways Sam manifests her low self-esteem is through magnifying her negative attributes and discounting the positive. Unfortunately, many of Sally’s attempts to offer supportive feedback result in the client providing more and more examples of how people view her negatively. Though Sam sees herself as fragile, she adamantly rejects compliments, and even states she wonders if people do this to placate her. One day, Sally pointed out the contradiction between Sam perceiving herself as passive while assertively taking issue with her lack of trust in people. Predictably, Sam again tried to counter this intervention with describing how this situation was different because it was not “real life.” Towards the end of the session, Sally remarked, “Wow, maybe I have been going about this all wrong. If this is your understanding of submissiveness, perhaps we should be trying to help you become more submissive!”


Was this an appropriate application of humor in the session? If so, was it germane to the individual’s reason for seeking therapy? If not, how did you see this as potentially destructive or ineffective?

How would you describe the target of the humor and the greater context it was being used?

Before using this intervention, what mitigating factors (e.g., interpersonal differences) or therapeutic issues (e.g., transference) would you have needed to assess in the client and therapist?

In what ways might you respond to the client’s reaction if the intervention was unsuccessful?

What other interventions might you consider in this situation – with or without the use of humor?


 

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