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Client populations and/or clinical issues you might struggle with based on your personal morals, values, and ethics AND your own personal experiences
Last semester I completed a cultural awareness assessment. After taking the assessment, I learned personal bias can interfere with my ability to help clients. I started to self-reflect and I realized that my thoughts and personal values can change with experiences and new interactions. For example, after graduating from high school, I attended Cleveland State University with a major in social work, eventually receiving my bachelor’s degree.
As I entered in the stage of a young adult, my impression of other ethnic groups was less favorable toward Asian American’s. My feelings were based on past experiences with an Asian American classmate who did not accept me because I am African American. As a result, I developed negative feelings toward Asian Americans, and I had no interest in learning about their culture. However, since then my impression of other ethnic groups is overall favorable.
At this stage in my life, I recognize that one person is not responsible for the decisions of another person regardless of cultural background. I choose not to judge people prematurely based on skin color, sex, religion, or disability. I choose to get to know people prior to making assumptions, and I treat all people how I want to be treated, despite negative experiences in the past. I am currently employed at the Department of Children and Family Services, as a child social worker.
I work with clients from all backgrounds and ethnicities and advocating for diversity is a top priority at DCF. However, I still feel uncomfortable with the possibility of working with Asian Americans.
Another area or population I may struggle with are victims of domestic violence, and mothers with substance abuse issues. Growing up I witnessed my mother being verbally and physically abused. I saw my mother’s daily functioning decrease and overall happiness diminish over the years. But despite the negative impact the abuse had on my mother, she never left my father and they remain married to this day. As a child, I remember feeling sad for my mother, but as a teenage I began to resent my mother for allowing my father to abuse her and allowing my siblings and I to witness the abuse. As a result, I have a personal bias against women who remain in harmful relationships despite the negative impact it has on them and the people around them.
I also have a personal bias against mothers that use drugs or alcohol while pregnant. I personally believe that mothers should protect their children and any drug use or alcohol consumption while pregnant is neglect. Over the last 5 years, I have had 4 miscarriages and I often wonder why I am unable to have a successful pregnancy. As a result, my personal experiences, morals and values may conflict with my ability to understand and engage the client. For example, I recently received a case about a mom who delivered her 10th child, positive tox. The client has never had custody of any of her children, all 10 children have been removed from her care. The client has a substance abuse problem, her drug of choice is heroin, cocaine, and fentanyl. The client resides in a shelter downtown. The client was recently arrested for human trafficking and she has told me on multiple occasions she does not want anything to do with her newborn child. The client does not have any known mental health issues and to my knowledge she has not experienced any significant trauma. The client has been using for approx. 13 years and has expressed that she has no desire to engage in treatment. All my efforts to build rapport and engage this client have been unsuccessful. However, despite the client’s lack of engagement and communication, I am still required to make reasonable efforts according to Ohio laws.
How might this affect your ability to work with these client populations?
I am aware that my personal bias and values may affect my ability to work with these client populations. A lot of my beliefs were formulated through past experiences and I fear my perspective of a client or issues may also be rooted in personal experience. This would not only create a challenge, but it can prevent me from engaging with certain populations. My personal values and beliefs can impact my relationship with client if I am judgmental, and I don’t allow the client to be open and discuss their issues in what should be a therapeutic environment.
In addition, how my personal values affect my ability to work with these clients, may also depend on my professional position. For example, if I am a social worker working independently, my judgement, actions, and perception can lead to unconsciously reinforcing stereotypes vs. working in an agency with polices in place and things are done a particular way. Again, my personal bias and values can also lead to microaggressions which can affect my ability to work with clients because I risk offending the client with my comments and or actions. Other possible ways this might affect my ability to work with these clients could be the possibility of biased decision making without consideration of cultural differences or client’s best interest. Clients may be reluctant to work with me, or even refuse to work with me. Clients may be less likely to participate in services, practice honesty, and or trust me. I risk the ability to build rapport or establish a therapeutic alliance. Lastly, my personal values, and beliefs can not only affect my ability to relate to the client but I could further damage the client by triggering internalized oppression.
How would you handle countertransference and transference in the client session?
When working with ALL clients I would be sure to set boundaries in hopes of avoiding transference and countertransference. In the event countertransference occurs and I find myself offended or emotionally triggered by a client, I would confront the client in a calm, empathic and direct manner and then work toward a resolution. Other ways I might handle countertransference could be consulting with peers or supervisors about my inappropriate feelings or reactions. I would also do a lot of self-reflection to explore my feelings toward the client and gain a better sense of self. Lastly, I would definitely make time for self-care to prevent any additional stress that may be causing me to react inappropriately.
When dealing with positive or negative transference I would attempt to help the client normalize their feelings and verbalize these feelings and discuss them together. I would also attempt to help the client see the difference between the original source of their feelings and myself. In the event, where I am unable to gain control of the transference, I would refer the client to someone else more skilled to work with them. However, I would try my hardest to recognize transference immediately to prevent damaging the therapeutic relationship and reacting inappropriately. However, if the transference is sexualized in any manner, I would address the behavior to bring the behavior to conscious awareness to avoid boundary violations.
How would you navigate doing clinical work with this population or clinical issue?
As a social worker our mission is to enhance the lives and well-being of all people regardless of race, age, sex, orientation, disability, or social class. I say this because I would navigate doing clinical work with this population, the same way as I normally would someone I didn’t struggle to work with. I would definitely focus on being aware of my personal bias to ensure I am providing effective care without unconsciously reinforcing stereotypes. I would attempt to build rapport as normal and work with the client to develop an appropriate treatment plan that we agree will be effective. I would practice actively listening and remain neutral to be sure I am not minimizing client issues, under diagnosing or over diagnosing client feelings and or symptoms. I would also focus on client strengths and prevention. I would assess the client without bias and attempt to relate to the client to provide the client with the best possible treatment options.
Furthermore, depending on the setting I am working in, I would take the necessary steps to help the client gain the skills to function normally throughout the day with the use of coping skills. I would encourage the client regularly. I would recognize the role of the client in treatment. I would plan, manage and provide social services if needed. I would screen medical records, conduct interviews, and set treatment goals as needed. I would attempt to involve family members and work with families to understand the nature of the issue their loved one is suffering from and provide them with ways they can help, encouraging them to support their loved one. I would advocate for the client, help them transition through difficult times and hard times. My primary goal would be to assist the client get the care he/she needs to sustain a healthy quality of life or daily functioning without recurrent negative symptoms, thoughts, or behaviors.
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