Week 13 Lecture Notes - Terminations and Transitions PDF

Preview

Summary

Lecture notes from Professor Georgena Haranis's Social Work Practice I class about social work transitions and the termination phase of a clinical relationship....

Description

Transitions and endings ● Types of terminations and endings ○ Unplanned terminations ○ Planned terminations with successful outcomes ○ Planned terminations with unsuccessful outcomes ○ Planned or unplanned service breaks ● Social worker responsibilities in the termination phase ○ To warn the client about termination and initiate the process ○ To evaluate the effectiveness of the service provided ○ To understand and cope with feelings about termination ○ To plan ways to maintain the beneficial changes that have occurred ○ To seek out and engage changes in a variety of situations ○ To seek out and engage the client in new services when that is indicated ● Warning and initiation and evaluation ○ SW must be aware of time limits, and warn clients. ■ Includes warning clients of breaks in service ○ Generally, the longer the service, the longer the warning period ○ Process of warning with children and needy clients may take several sessions ○ Evaluation of services includes: ■ Giving the client the choice of data to review ■ Allowing them to use their own words to describe the change ■ Inquiring about perception of the causes of the change. ● Evaluation of the social worker by the client ○ Questions that can be used to evaluate the social worker: ■ What actions did you find most/least helpful? ■ What actions would you have liked me to take that I didn’t take? ■ Were there personal qualities of mine you found helpful/not helpful (e.g., ways of speaking, timing if comments, sense of humor, ways of expressing myself)? ■ How well do you think I understood what you were thinking or feeling? ■ How honest and open did you experience me as your worker? ■ In what ways did you/did you not experience me as supportive and caring? ● Understanding and coping with feelings and responding to termination reactions ○ Anger ○ Denial ○ Avoidance ○ Other feelings? ○ Reporting Recurrence of Old Problems ○ Introducing New Problems ○ Attempting to Prolong Contact ○ Finding Substitutes for the Social Worker ● Maintaining change ○ For change to be maintained, one or more of these factors must be present:

■

●

●

●

1. The client system must have changed in ways that are directly related to the life situation that brought them into service. The client system must have acquired the knowledge, skills, and/or attitudes required to function better in that situation. ■ 2. The client system must continue to receive reinforcement, rather than punishment, for the behaviors associated with the changes. ■ 3. The client system must have access to the resources they will need to continue the changes. ■ 4. The client system must have a means of “self-control” for resolving problems that arise in the future that prevent a continuation of the new pattern of behavior. ● At termination, put in place a plan that addresses these principles Failure to maintain gains attributed to ○ A natural tendency to revert to old habits ○ Personal and environmental stressors ○ Lack of opportunities in the environment for the social and leisure activities ○ Absence of positive support system ○ Inadequate social skills ○ Lack of reinforcement for functional behaviors ○ Inadequate preparation for environmental changes ○ Inability to resist peer pressures ○ Return to dysfunctional family/community environments ○ Inadequately established new behaviors Utilizing changes in a variety of circumstances and engaging in new services ○ Help the client to select other circumstances and generalize learned skills to these circumstances. ○ If clients need new/additional services, discuss their expectations and any anticipated barriers to their use. ○ Regarding groups… members should help each other express feelings. Group members are leaving individual associations, and those with the group as a whole. The tasks of ending and transitions ○ Announcing the process: “Now we are ending.” ■ Responsibility for marking ending time, of sessions and overall work, is the job of the clinician ○ Acknowledging and exploring reactions to endings ○ Remembering “Where were you when we began.’ ○ Reviewing highlights of the work together: “What have we gotten done?” ○ Foreshadowing the future: “Where are you heading?” ○ Checking for unfinished business: ”Is there anything we should cover before closure?” ○ Giving and eliciting feedback about the meaning of the relationship: ” What has this meant?” ○ Addressing issues around future contact

●

●

●

●

●

○ Giving and receiving mementos ○ Saying Goodbye Stages of the ending phase ○ Denial ○ Indirect and Direct Expression of Anger ○ Mourning ○ Trying it on for size ○ The Farewell-Party Goal for good endings ○ Relationships and work will be internalized as a guiding and sustaining memory. ■ Memories can encourage the client ■ Internalization is demonstrated by picturing or envisioning the worker’s support or emulating the worker’s language, mannerisms, etc., or deciding to try a strategy the worker had accepted or spontaneously saying or doing things learned through the work ○ Examine client’s coping capacities ■ Bringing resources or skills to bear when challenges arise ■ Realistic and reliable planning and follow through ■ Positive and sustaining view of themselves, the world and the future ■ Having systems in place for companionship, support, and emergencies ■ Established style for dealing with change and loss Steps in ending ○ Making meaning of work – clients should reflect on and articulate what they have learned ○ Highlighting gains and achievements – compare where clients were and where they are now ○ Expressing thoughts and feelings about endings – both client and worker should do this ○ Linking current reactions to prior experiences Endings ○ We reenact our maladaptive coping responses in the helping situation (psychodynamic) ○ Endings are beginnings; it’s a commencement (humanistic/existential) ○ Parallel process between our own endings and those in our work life; our own attachments (psychodynamic) ○ What our thinking is related to “endings;” (cognitive-behavioral) ○ Abrupt Endings often result in: ■ Minimizing the importance of relationships ■ Minimizing the signs of risk ■ Packing everything in at the end ■ Poor case management of referrals and transfers Mistakes and special considerations ○ Mistakes ■ Lack of attention to structure

●

●

●

■ Missing strengths ■ Misattribution of causation ■ Pressure from the client ■ Priorities can’t be determined by the client ■ Involuntary clients ○ For clients with schizophrenia ■ Using ego psychology, the social worker monitors the client’s reality testing, judgement, affect, defenses, relationships, sense of self, ability to manage stimuli, and sense of mastery ■ Positive relationship with the SW, an essential component of this work, models the process for a person with schizophrenia to examine other relationships ■ Common problem is the inability to regulate interpersonal boundaries Steps related to termination for clients with schizophrenia ○ Factors likely to influence the client’s response to ending: ■ Degree of positive change ■ Satisfaction with the intervention ■ Personality style ■ Levels of attachment and dependency ■ Previous experiences with loss ■ Current supports available ○ Use supervision/colleagues to assess own attachment or detachment from client ○ Validate the client’s feelings about ending ○ Attend to acting-out behaviors in clients who can’t articulate. ○ Activities/topics to discuss: ■ Everyone’s life is a continual oscillation between togetherness and parting ■ Review client’s methods of coping with separation, dependence and anger ■ Review the client’s past, presence, and future Consolidating gains and planning maintenance strategies ○ Managing the emotional and behavioral reactions to ending ○ Summarizing and stabilizing the changes achieved ○ Developing a plan to sustain those changes ○ Similar goal in work with groups ■ Assist members to interact successfully ■ Ability to transfer their new skills to other relationships Social workers’ reactions to termination ○ Repeatedly working on cases without closure and treatment is ended without reaching treatment goals results reduces job satisfaction ○ Premature terminations that become the norm can lead to burnout and deceased sensitivity to clients...