Introduction
Damon House is a non-profit organization whose mission was formed to establish and maintain a residential program for those suffering with substance abuse disorder and drug dependence and to rehabilitate those persons. In addition, Damon House stresses the importance of encouraging those with substance abuse disorders to seek treatment and aid them in independent living. Damon House also seeks to enhance public awareness of the nature and effects of the use of drugs and to stimulate public interest in the benefits of prevention of addiction and the benefits of treatment and re-socialization of addicts (Damon House, 2017).
Client Identifying Information and Referral Information
Sean, a 37-year-old Caucasian male has an addiction to heroin and cocaine. The client has been in drug court for 4 ½ years and is no longer eligible for drug court in February. Sean’s father is in jail for murder, so Sean grew up with his father absent through most of his life. Sean is an only child, living with his mother until he was 17 years old, when he moved in with his then girlfriend, age 14, who later became his wife. Sean started heavily drinking and using drugs once living with the girlfriend, stating they were both hosting high school parties weekly to keep up with the “in crowd”. Client has a history of violence, drug abuse and has been on and off in rehab programs and relapsing for years. He spent four years in jail due to a burglary charge in 2016.
Sean believes despite his drug addiction, he has been able to maintain a normal lifestyle. Client separated from his wife after 14 years, who is also an addict. He has three children with her. The ex-wife is no longer involved in raising the children as he currently has shared custody with his mother. The client is currently in a new relationship with a woman who is also a recovering addict. The client states that he struggles with balancing his own recovery as well as balancing hers. Despite that, the client has a positive outlook on his future and has a desire to leave the program with a fresh start for his children, hoping to learn from his mistakes and manage his addiction better than he has in previous rehabilitation centers.
Sean was referred to the agency, Damon House, through drug court due to multiple relapses. The client will complete drug court prior to completing the program; however, based on intake information, the client was referred to this program simply as a last option before he graduates from drug court.
Presenting Problems and Problem-For-Work
Sean’s identified presenting problem is his addiction to heroin and cocaine and his violent behavior. The client is in the behavior modification program to understand the nature of his addictions and what it stems from. Sean presents a sense of superiority and reports feeling that he is more mature than the other clients, stating he has a better sense of understanding his addiction compared to other addicts. This is something that will continue to be evaluated given that despite this sense of superiority, the client has been in and out of several programs, relapsing on more than one occasion. The client states that he tends to look to fix the problems of those around him, such as his current girlfriend’s recovery, to ignore his own problems.
The problem-for-work will focus more on the client’s defiant and aggressive behavior, as well as his need to “be the hero” for his loved ones. The client mentions his aggravation when his advice to others is not taken, for he feels he knows what is best for everyone. It will be important to further discuss healthy coping skills and methods to decrease future outbursts within the program as well as once he completes the program. The goal is to help modify Sean’s current behaviors to prevent future relapses.
Medical History/Family History/Educational Background
Sean was raised by a single mother for most of his life. He has no other siblings. His parents were married for 10 years, with his father in an out of jail due to drug related convictions. When Sean was ten years old, his parents separated. When he was 14, his father was convicted of murder and sentenced to life in prison. Sean has not seen his father since.
By the time Sean was 17, he had been kicked out of his mother’s home when his girlfriend’s family took him in. He had not lived at home since. Sean’s highest education is a high school degree, but has intentions of furthering his education once he is done with the program. His mother, Susan, lives and takes care of Sean’s one daughter and two sons, ages six, nine and sixteen, respectively. At age 26, Sean was diagnosed with generalized anxiety disorder and is currently taking 100mg of Zoloft to maintain his illness.
Observations
Sean and I met for the first time at my agency, Damon House. We met in one of the counselor offices to keep the session as private as possible. The first meeting was intended to be an introduction so I could have a better understanding of Sean’s history and his drug addiction. Sean was reluctant and did not discuss his history as in depth as desired. He was not interested in being my client, stating, “I don’t know how much you can help me. I respect that you’re an intern, but unless you’ve been an addict, you don’t know what it’s like,” before ending our first session. It was uncomfortable, but I was expecting to run into a situation like that at some point throughout my time at Damon House. Sean tends to talk about the 12 steps to recovery and what he would learn in previous programs. I knew that this was a different type of program and that was not our goal of discussion, but for our first session I allowed him to talk freely to gain his trust. I wanted Sean to feel comfortable talking to me and establish a feeling of being able to discuss freely what is on his mind. Because of his guarded behavior, continued engagement and relationship-building will be needed in future sessions to establish a rapport with the client (Hepworth, Rooney, Rooney, & Strom-Gottfried, 2017).
Beginning Engagement
As I met with Sean for the first time, I used Shulman’s (2009) third level of tuning-in by observing the client’s general concerns and fears during the session. According to Shulman (2009), it is important to recognize the behavior of the client and whether he presents himself as hopeful, guarded or even both. Sean has been in several different programs prior to Damon House, so when preparing for our session, I gathered that he may be reluctant about the program. Some of my thoughts included were, “clients who have been unsuccessful in multiple programs may have a sense of hopelessness. Continuous relapses may present a sense of failure within a client; therefore, he may not be as willing to engage in the program.” With this thought process, I knew I had to relate back to tuning-in. Shulman (2009) mentions the importance of self-awareness. Knowing the client will most likely show resistance toward wanting help from a social worker may show in the way a social worker responds. Though using the tuning-in skill is important in preparation with meeting a client, it can also develop a negative view on the client before giving the client a chance (Shulman, 2009).
Here is how the first session began:
Jillian: Hello Sean, as you know, my name is Jillian and I am a Social Work student. We’re going to be meeting once a week throughout your six months here in the program. Would you mind telling me a little bit about yourself?
Sean: I don’t really know what you want me to say.
Jillian: (here is where I began noticing his resistance) Just a little bit about why you are here and what you want to gain from this program.
Sean: Okay, well I max out of drug court in February. This was pretty much their last resort for me. I’ll be finished with drug court before I finish this program, so it doesn’t make much sense but whatever. I’ve done the whole program thing before. I know the steps, I know the system. I’ve relapsed more times than I can count. But I do want to stay clean. I want to go back home to my kids. I want to move on with my life. As for what I want in this program? I don’t know. I guess I just want to learn something from this experience. It’s different than other programs. So, let’s see if this one will work.
Jillian: When you say you want to learn something new, what do you have in mind?
Sean: I don’t know. I’ve only been here for two weeks, I still don’t know what I want yet.
Jillian: Okay. So, what I would like from you, following this session for next week, is to write out a list of potential short-term and long-term goals you have. It could be anything you want to gain within the next six months. But, this way we can work on where to go from there. Sound good?
Sean: Yeah, I can do that.
Jillian: Okay, great. Is there anything else you would like to talk about?
Sean: No. Not really. To be honest, I don’t know how much you can help me. I respect that you’re an intern, but unless you’ve been an addict, you don’t know what it’s like.”
Jillian: Well, maybe we can both learn from each other then.
Sean: Yeah, maybe.
Within a short period of time while speaking with Sean, I could already notice a
resilience toward treatment. Shulman’s (2009) third level of tuning in became prominent when the client suggested a lack of faith in learning from a social work student. At that moment, I contemplated whether self-disclosure would be appropriate. Though I do not know what it is like to be in the client’s situation, I do have experience in my personal life when it comes to addiction within my own family. However, I chose not to disclose any personal information now. Being only a student, I felt I needed to establish larger boundaries with my clients until I am better educated on self-disclosure and boundaries between a social worker and cliet.
Though there is not an ethnic diversity between my client and I, he is an older male while I am a younger female. When the client admitted his hesitance, I could relate to Shulman’s (2009) impact on diversity competence. According to Shulman (2009), there are three concerns that clients experience when working with practitioners who are of a different gender, race or orientation (inter-ethnicity); one concern being whether the worker is trained and skilled enough to handle diversity. The client dismissed my potential before giving it a chance. I knew I would eventually have to break this stereotype at some point in our future engagement.
Case Theory
Though not much yet has been discussed about Sean’s childhood, his need to help others and be the “hero” as he stated, shows a potential fault between Sean as an infant and his caregivers (Page, 2011). According to the attachment theory, Page (2011) stresses the importance in quality of caregiving from the beginning at birth, molding the child depending on the needs for safety and protection and whether those needs are satisfied. Because Sean has this need to be a caregiver, gravitating toward relationships where his significant other depends on him, it is possible that Sean developed an insecure attachment throughout his childhood. In fact, according to Hutchison (2015), parents who have a history of substance abuse are four times more likely to neglect an infant or child compared to other parents. Since Sean grew up with a father continuously in and out of his life due to substance abuse related charges, it is possible he formed this insecure attachment, gravitating toward those who are anxious preoccupied adults (Hutchison, 2015).
Because of the possible neglect throughout childhood, it is possible that Sean learned that problems can only be solved with aggressive behavior. Since his father was in prison throughout most of Sean’s life, with his final sentence being convicted of murder, it is safe to assume Sean was exposed to violence growing up. According to Walsh (2006), Sean’s impulsivity and aggressive behavior gained him attention, albeit negative attention. Even though this behavior may have been accepted within his home growing up because of his father, this type of behavior is not accepted in other environments, especially as a person grows older. Sean mentioned his assault charges leading up to entering this program. It is possible he has trouble adjusting to other situations different than his home life. Sean appears to find adjusting to more structured environments to be challenging (Walsh, 2006), which could possibly be a reason Drug Court referred him to a behavioral modification program in the first place.
Social constructionism (Wood & Tully, 2006) helps to understand how Sean’s behavioral issues formed throughout his life. There is a considerable amount of evidence that shows Sean having a problematic home due to his father. This hostility at home led Sean to seek comfort and happiness elsewhere; therefore, becoming the type of teenager who developed a reputation of throwing parties and drinking every night to “fit in.” Because society put this pressure on the client, Wood & Tully (2006) believe a problem like Sean’s is less psychological and more societal. If Sean was brought up in a different environment, he may have gone on a different path. Though, we do not know for sure if that is accurate, it is safe to assume much of Sean’s behavioral and addiction problems come from social constructs in his lifetime.
References
Damon House. Rehab Program. (2017). Retrieved from http://www.damonhouse.org/
http://www.damonhouse.org/
Hepworth, D., Rooney, R. H., Rooney, G. D., & Strom-Gottfried, K. (2017). Direct social work practice: Theory and skills, 10th ed. Boston, MA: Cengage Learning.
Hutchison, E.D. (2015). Dimensions of human behavior: The changing life course (5th ed.). Los
Angeles: Sage Publications.
Page, T. (2011). Attachment theory and social work treatment. In F. Turner (Ed.).Social work treatment: Interlocking theoretical approaches (5th ed., pp. 30-46). NY: Oxford University Press.
Shulman, L. (2009). The skills of helping individuals, families, groups, and communities
(6th ed.). Itasca, Illinois: F.E. Peacock Publishers, Inc.
Walsh, J. (2006). Theories for direct social work practice. Belmont, CA: Thomson Brooks/Cole.
Wood, G.G., & Tully, C.T. (2006). The structural approach to direct practice in social
work: A social constructionist perspective (3rd ed.). New York: Columbia University Press.