The home environment plays a critical role in defining how children’s develop. For healthy development, stability and strong support is needed. It is true that most homes in the United States provide an environment that allows children to experience healthy growth. However, for millions of children, healthy development remains elusive since they are from homes that are defined by such hardships as poverty, substance abuse, physical violence and sexual abuse. Social workers have the mandate to respond to the plight of these children. They need to take all necessary steps to insulate vulnerable children against substance abuse and sexual violence. In order to be effective in attending to the needs of victims of violence and substance addiction, social work practitioners need to possess the required skills and establish strong bonds with the children. In my job as a social work intern, I have observed that understanding the needs and backgrounds of children enables me to leverage my engagement skills to establish healthy relationships that enhance healing.
Biopsychosocial Assessment
Biopsychosocial assessment is among the most critical processes that allow social workers to execute their mandate. Essentially, this assessment is concerned with seeking to understand the behaviors, histories and backgrounds of clients (Barkley, 2009). By conducting the assessment, the practitioner is able to develop interventions which account for the unique experiences of their patients. In the following section, the results of a biopsychosocial assessment of one of the clients with whom I worked at my agency are offered. The purpose of this section is to underscore the critical role that the assessment plays in providing practitioners with insights needed for the delivery of holistic care.
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History
The importance of assessing the history of a client cannot be overstated. By assessing the client’s history, a social work professional is able to identify the factors that are responsible for the problem for which the client is seeking help. Furthermore, the history assessment allows the practitioner to determine if the interventions that have been adopted in the past were effective. In my work, I encounter children from a wide range of backgrounds. Most of the children have suffered various forms of abuse and many grapple with substance abuse. There are also children and young adolescents who encounter hardships as they strive for excellence in their academic pursuits. Among the clients whom I have dealt with is Nelson, an 18 year old who is originally from Namibia in Africa. In an effort to understand his needs, I conducted an interview which shed light on his history. Thanks to the intervention of our agency, Nelson was placed in a foster home after his biological mother proved unable and unwilling to provide him with the care that he needed. For example, being a Diabetic, Nelson requires daily insulin injections. His biological mother constantly failed to administer these injections. Additionally, Nelson who had been referred to the agency by an organization which works closely with foster care agencies shared that he has lost his brother to gang violence and that his father abandoned the family. Currently, Nelson stays with his foster mother who is a retired nurse. He noted that at the foster home, he has found fulfilment and love. Another issue that Nelson spoke about during the interview is that he has experimented with such drugs as marijuana and alcohol. After pressure from his mother and teachers, he abandoned these substances. However, he expressed a fear that the challenges that he continues to face push him toward these substances. His academic performance has also suffered. Since he is unable to attend school consistently, he has registered a worrying decline in academic performance and discipline levels. Overall, the assessment of Nelson’s history shows that he has grappled with serious challenges and that additional interventions are needed so as to sustain the encouraging progress that he has made.
Current Functioning
While a client’s history provides social workers with vital information, they can gain better and more reliable insights by assessing the client’s current functioning. This assessment allows for the needs of the client to be established and for appropriate interventions to be developed (Corcoran & Walsh, 2010). When he visited the agency, Nelson exhibited behaviors which suggested that he is in dire need of help. For example, his school attendance remains spotty and he seemed intoxicated. Since he is only 18, these behaviors are indeed worrying. Researchers have established that substance abuse among teenagers is responsible for a wide range of negative outcomes. They include impaired brain development and engagement in such risk behaviors as drunken driving (Scherer, 2013). Nelson’s poor academic performance serves as evidence that his consumption of alcohol is having damaging impacts on his cognitive functioning. As already noted, he was referred to the agency by a community-based organization which believes that unless urgent interventions are implemented, Nelson will either be recruited into a gang, abandon his studies or become a drug addict. The concerns that this organization raised underscored the need to provide Nelson with all the support that he needs.
Engagement Skills
The effectiveness of a social work practitioner hinges on their capacity to exploit their engagement skills to understand the needs of clients and to develop warm relations. Basically, engagement skills refer to the competencies that a social worker can use to create rapport and building strong relationships with the client (Marais & Van der Merwe, 2016). Empathy is among these skills. It has been established that when they demonstrate empathy, practitioners enhance the effectiveness of the interventions that they implement (Jani, Blane & Mercer, 2012). Furthermore, through empathy, the practitioners manage to establish trust and confidence-based relationships with clients. In all my sessions with Nelson, I strived to demonstrate empathy. Instead of passing judgment, I attempted to understand his struggles and anguish. I constantly assured him that none of the challenges that he experienced were the result of his own failures. In response to the empathy that I displayed, Nelson opened up about his fears and expressed confidence that our interactions would allow him to find healing and adopt behaviors which enhance his growth.
While it is important, empathy is not sufficient to allow for the creation of effective relationships with clients. It is important for practitioners to combine this skill with elaboration for maximum impact. Basically, elaboration is concerned with providing explanations and responding to any concerns that the client raises. It is not uncommon for misunderstanding and confusion to arise during sessions with clients. For example, the practitioner may use professional jargon that the client is unable to understand. For the practitioner to effectively address the need of the client, they should use simple language. I fully understand the critical role that elaboration plays in the social work process. In accepting to handle Nelson’s case, I recognized that he was a young adult who lacks familiarity with social work concepts. To ensure that no confusion arose, I answered all the questions that he posed. Additionally, I sought confirmation from him that he understood the process and that our interactions were having the desired impact. My engagement with Nelson has enabled me to appreciate the function that elaboration plays in promoting healing for clients.
In the United States, foster care has gained a negative reputation. It is reported that children placed in foster homes suffer abuse and grapple with hardships (Phillips, 2017). I was therefore not surprised when Nelson expressed concerns about being placed in a foster home. He shared that he feared that he would suffer the same abuse and neglect that he faced in the hands of his biological mother at the foster home where he had been placed. I leveraged my skills to elaborate that while his fears were valid, the agency would take steps to ensure his safety and wellbeing. For example, I assured him that before placing a child in a foster home, the agency conducts a thorough scrutiny and verification process. The purpose of this process is to ensure that the foster home is adequately equipped to attend to all the needs of the child. I also reminded Nelson that if the agency receives report that a child that it has placed in a foster home is facing hardships, the agency intervenes. I found that the assurance that I issued had a calming effect on Nelson.
Client-Worker Relationship
Healthy and strong relationships between clients and social workers are at the heart of effective interventions. If they are to gain a full understanding of the hardships that their clients face, social workers need to persuade the clients to enter into relationships that are established on trust. As a social work intern, I am required to perform such functions as visiting clients in foster homes and ensuring that they are making good progress in school. In addition to visiting Nelson at the foster home, I also spoke regularly with his teachers about his performance and engaged in lengthy discussions with his foster mother. The purpose of the discussions was to identify solutions that we can implement to further improve Nelson’s health. In the following section, I provide details about the nature of the relationship that I created with Nelson. Furthermore, I shed light on the transference and counter-transference issues that defined this relationship.
Transference and Counter-transference Issues
Within the context of counseling, transference refers to the tendency by clients to project their feelings about a particular individual on the practitioner (Walsh, 2009). If not addressed in good time and properly, transference can have damaging impacts on the relationship between the practitioner and the client. I observed that transference was being manifested in my interactions with Nelson. Initially, he was hostile and distrustful. He refused to share details of the hardships that he faces at home. Furthermore, he was unwilling to admit that his academic performance had declined and that he had an alcoholism problem. I attributed his reluctance to open up to his unhealthy relationship with his biological mother. Since his mother was abusive, he had become distrustful of authority figures and adults in general. Thanks to the empathy and understanding that I displayed, I was eventually able to gain his trust. However, I still felt that Nelson projected his distrust of his biological mother onto me. His case is a representation of the adverse outcomes that result from transference. Unless the client agrees to collaborate with the practitioner to find solutions that work, transference will frustrate the healing process.
Counter-transference is yet another process that shapes the work of social workers. Basically, counter-transference concerns the emotional responses that the practitioner directs at the client (Walsh, 2009). As is the case with transference, counter-transference can also impede the relationship between the client and the social worker. However, when used appropriately, counter-transference can have a beneficial impact. As part of this assignment, I reflected on my interactions with Nelson and observed that counter-transference was at play. I realized that on numerous occasions, I had unconsciously projected my frustrations onto Nelson. For example, after noting that we were not making meaningful progress, I used harsh language and adopted a hostile tone. In addition to eroding the strength of our relationship, my outburst also caused Nelson to question whether I was properly positioned to deliver the help that he needed. As a result of my supervisor’s intervention, I was able to address my disappointment and frustration and restore the sobriety which had initially defined my interactions with Nelson. I now recognize that in order to remain objective, social workers need constant monitoring and support from such parties as their supervisors.
Management of Feelings and Reactions
Emotional intelligence is among the competencies that enable social workers to transform the lives of their clients. Basically, this skill is concerned with the ability to understand one’s emotions and respond properly to the emotions of others. Such emotions as positivism and resilience are understood to have a positive impact on the engagement between social work practitioners and their clients (Collins, 2007). As they seek to understand the struggles of their clients, the practitioners should adopt proper approaches for managing their feelings and reactions. In recognition of the critical role that emotional responses play, I have developed techniques that have helped me to ensure that my emotions do not negative affect how I relate with my clients. Seeking feedback from the client and my internship supervisor is one of these techniques. Thanks to the feedback that I receive, I am able to determine if my emotional displays and responses are appropriate. For example, on the question on the impact that my services had had, Nelson shared that he found me to be professional and tremendously helpful. My supervisor confirmed that for the most part, I had maintained high levels of objectivity and professionalism.
In addition to seeking feedback, I also take breaks from sessions with clients to recharge. The mandate that social work interns are required to fulfill can be overwhelming. We are required to listen to the problems that our clients have and walk with them as they seek solutions. Whereas it is true that the education, experience and training that we have acquired should enable us to cope with the demands of our work, we often suffer frustration and fatigue. I therefore find that regular breaks are critical for social workers to secure their own wellbeing. A social worker who feels overwhelmed may be unable to provide their clients with the help that they need. I would strongly encourage other social work professionals to invest in their own wellbeing so that they remain committed to their obligation of helping clients to find healing. I admit that there have been instances where I have managed my emotions poorly. For example, in the discussion above, I have shared that I expressed my frustration at the lack of progress. My failure to contain and express my emotions in a healthy fashion could have had devastating effects on the relationship with Nelson. I feel the need to acknowledge that the constant support that my agency offered has allowed me to demonstrate maturity in the expression of my emotions. The encouraging progress that I continue to make as I help Nelson address his challenges serves as evidence that organizational support facilitates social work. While I maintain that it is important for social workers to remain professional, I also feel that they need to embrace their human and natural responses. I think that when they express their emotions freely, social workers allow their clients to understand that they are also human who share in the struggles that the clients grapple with.
In conclusion, guiding clients in their quest for solutions to the problems that they face is deeply satisfying. I have found tremendous fulfilment as I work with children who have suffered abuse and are grappling with substance abuse. I represent the thousands of social workers who go great lengths to ensure that their clients find the help that they need. Nelson is among the dozens of children who have provided me with the opportunity to showcase the critical role that social work plays in creating healthy communities. He approached my agency in the hope of staying clear of substance abuse and improving his academic performance. While it is still early to confirm that our services have addressed his problems, I am confident in stating that he has undergone significant transformation. I attribute this transformation to the processes that I have employed in our interactions. The success that I have had shows that when they create trust-based relationships with clients, social workers manage to rid clients of the problems that they face.
References
Barkley, J. (2009). Biopsychosocial assessment: why the biopsycho and rarely the social? Journal of the Canadian Academy of Child and Adolescent Psychiatry, 18 (4), 344-7.
Collins, S. (2007). Social workers, resilience, positive emotions and optimism. Practice, 19 (4), 255-69.
Corcoran, J., & Walsh, J. (2010). Clinical assessment and diagnosis in social work practice. Oxford: Oxford University Press.
Jani, B. D., Blane, D. N., & Mercer, S. W. (2012). The role of empathy in therapy and the physician-patient relationship. Forsch Komplementmed, 19 (5), 252-7.
Marais, C., Van der Merwe, M. (2016). Relationship building during the initial phase of social work intervention with child clients in a rural area. Social Work, 52 (2). DOI: http://dx.doi.org/10.15270/52-2-498
Phillips, K. (2017). After a lifetime of foster homes and abuse, a 14-year old broadcast her suicide on Facebook. Washington Post. Retrieved December 8, 2018 from https://www.washingtonpost.com/news/post-nation/wp/2017/03/16/after-a-lifetime-of-foster-homes-and-abuse-a-14-year-old-broadcast-her-suicide-on-facebook/
Scherer, L. S. (2013). Underage drinking. Farmington Hills: Greenhaven Publishing.
Walsh, J. (2009). Theories for direct social work practice. Boston: Cengage Learning.
