Discussion: Social Economic and Environmental Justice

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Working With Families: The Case of Carol and Joseph

Carol is a 23-year-old, heterosexual, Caucasian female and the mother of a 1-year-old baby girl. She is currently unemployed, having previously worked for a house cleaning company. The baby is healthy and developmentally on target, and she and the parents appear to be well bonded with one another. Carol lives in a rented house with her husband, Joseph. Joseph is a 27-year-old, heterosexual, Hispanic male. He was recently arrested at their home for a drug deal, which he asserts was a setup. Both parents were charged with child endangerment because weapons were found in the child’s crib and drugs were found in the home. The parents assert that the child never sleeps in the crib but in their bed. As a result of the parents’ arrest, social services was notified, and the child was temporarily placed in a kinship care arrange- ment with the maternal grandmother, who resides nearby. As a result of Joseph’s arrest, he was fired from the cleaning company where he worked, and the family is now experiencing financial difficulties.

After initial contact was made with the parents, a number of concerns were noted and the family was recommended for addi- tional case management. Carol’s mother indicated that she had concerns about Carol’s drinking habits and stated that Carol’s father and grandfather were alcoholics. She and the father sepa- rated when Carol was a baby, and Carol has had only limited contact with him. There appears to be significant tension between the grandmother and Carol and Joseph. I addressed the alcohol issue with both parents, who denied there was a problem, but shortly after the discussion, Carol was involved in a serious car accident with the baby in the car. She was determined to have been under the influence of alcohol. I advised Carol that she could not have any unsupervised contact with her child until she completed intensive inpatient substance abuse treatment. I made arrange- ments for her placement, but after a week, she was discharged for noncompliance with the rules. She was then referred to an intensive outpatient program and began therapy there. Initially

 

 

PRACTICE

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her attendance was erratic because she had lost her license as a result of the DUI. Eventually, however, she became engaged in the program and began to address her issues. She acknowledged that she had started using drugs at a very young age but said that she had only begun drinking in the previous year or so. We discussed the genetics of her family, and she said that she realized that she had deteriorated rapidly since beginning to drink and knew that she simply could not drink alcohol.

Joseph’s mother is deceased, and his father travels exten- sively in his job and is not available as a support. Joseph was very devoted to his mother and was devastated by her premature death. We discussed the strengths that he and Carol demonstrated in staying together and working out their problems. Joseph indi- cated that as a Hispanic man, family is very important to him and he wants his family to stay together. Although they have been struggling financially, Joseph has obtained stable employment landscaping for a large development and said he plans to take courses at the community college to learn the trade. He stated that he wants to provide a good life for his child. Carol has a lot of unresolved issues to deal with in therapy, not the least of which is the accident that could have killed her child and the legal ramifica- tions that resulted from this incident. Although angry and hostile at the beginning, through the implementation of person-centered therapy, we were able to establish agreed-upon goals that showed respect for the client and encouraged her to find solutions to her problems. Although our relationship was tenuous at times, providing encouragement to her rather than judgment enabled her to forgive herself and take corrective action. Discussion: Social Economic and Environmental Justice

 

 

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the common myth that a traditional therapy office setting is necessary to do “clinical work.”

Through this case, students can also witness how treat- ment goals can shift throughout the course of treatment. This is evident in the step-by-step growth that Pedro demon- strated. Each shift in treatment goals resulted in a change or deepening of our relationship and gave Pedro the opportunity to address more difficult issues as time went on.

Working With Families: The Case of Carol and Joseph 1. What specific intervention strategies (skills, knowledge,

etc.) did you use to address this client situation? This case required extensive use of active and passive listening

and patience to enable the client to become sufficiently comfort- able with me and to arrive at a point where she could work on her issues. Initially she was very angry, hostile, resistant, and very much in denial.

2. Which theory or theories did you use to guide your practice? I work with people in their homes, which is their territory, not

mine. I think it is very important to be aware of how I would feel if I were in their shoes. The person-in-environment perspective and Carl Rogers’ person-centered approach are crucial here.

3. What were the identified strengths of the client(s)? She was smart and had a good support system in her husband

and mother, who were very supportive during her treatment. 4. What were the identified challenges faced by the client(s)? Carol was a severe alcoholic and had a drug problem to a lesser

extent. She had psychological issues as well, including low self- esteem, depression, and anxiety. She also had transportation and legal problems as a result of losing her driver’s license after the DUI.

5. What were the agreed-upon goals to be met to address the concern?

The primary goal was to protect her child by keeping Carol sober and finding the intervention method that would be most appropriate for her to do that. This took time due to the resist- ance to treatment.

 

 

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6. How would you advocate for social change to positively affect this case?

Treatment options and access to them need to be improved in rural areas. There were not many choices for this client, and losing her license in an area with no public transportation greatly affected her ability to seek treatment.

7. Is there any additional information that is important to this case?

I subsequently found out that there had been other serious episodes concerning Carol’s drinking that the family had failed to disclose to me because they were covering up for her.

Carol’s parents separated when she was very young, so she was mostly cared for by a family friend and grandparents. Carol’s mother seemed to have resented the child’s interference with her social life, and clearly the daughter resented her mother’s lack of involvement with her. Carol’s mother, who was from a Southern White Protestant family, seemed uncomfortable with Joseph’s culturally unfamiliar Hispanic Catholic background. She reported to me that she felt the son-in-law was lazy and did not work in the early stages of his relationship with her daughter, who she said worked very hard. During my involvement with this couple, I found Joseph to be hard working and doing his best to provide for all of them. He was very committed to doing whatever was necessary to keep his family intact, even if his judgment at times was poor. Discussion: Social Economic and Environmental Justice

Working With Immigrants and Refugees: The Case of Aaron 1. What specific intervention strategies (skills, knowledge,

etc.) did you use to address this client situation? I used support, active listening, reflection, reframing, and vali-

dation with the client, and I recognized the importance of structure, reliability, and predictability of the social worker in the therapeutic alliance.

2. Which theory or theories did you use to guide your practice? I used family systems theory, multicultural family theories, and attachment theory.