Interventions
All names have been changed to preserve the confidentiality of clients.
1. Encouragement with Kristen
Overview
Encouragement is one of the simplest yet, powerful interventions. It is something that people do often just in normal conversation. For encouragement to be effective, it must be given using specific examples for proof of why you think they can do the task. In addition, if it is not sincere, it is not effective. It can be used to give encouragement to continue trying, or to do something hard. There really are no limits to what situations you can use encouragement in.
Need Addressed
Kristen was returning home after her time at Aspiro. She struggles with change and is afraid to return home because she fears she will fall back into her old habits. As she prepares to return home she expresses these concerns to me as she wonders if she will be able to accomplish this hard task.
Intervention Used
Kristen and I stood talking as before she was to return home. She said, “I am scared about going home. I am afraid I won’t be able to keep changing, and will fall back into my old patterns. I also am afraid I won’t be able to make new friends.” I responded, “You can do this. It will be hard but you can do hard things. I have seen you face your fear of heights on the rappel at Corona Arch. I have seen you as you have struggled to accomplish hard things that took time like that hike up Coyote Gulch to Crack in the Wall. You have made friends here at Aspiro and have helped so many people, like Jane when she was feeling home sick and John when he was sad about his dog. You have many talents that will help you make friends like your ability to listen to others well, and you care and concern for them. Going home will be hard but I have seen you do hard things and know that as you keep trying you will be able to live the life with the changes you desire.”
Assessment
This intervention went well because I was able to name specifics that were meaningful experiences to her in which she felt she had accomplished hard things. I realized that in order for encouragement to be encouraging it must be done in a way that does not patronize the client or dismiss their feelings. Even if specifics are given, their concerns and feelings must be validated. If not, they are less likely to be receptive and feel empowered by what is said.
2. Universalization with Suzy
Overview
Universalization
is a technique that assists the client in not feeling alone or that they are
the only who has gone through or felt what they are experiencing. To do so, the feelings and problems are not
minimized rather they are presented in a way that helps them know what they are
going through is normal. This intervention
gives the client hope for the present and future, and peace of mind.
Need Addressed
Suzy is a
mother of a patient at the hospital.
Suzy’s need was to understand that her feelings of stress are normal.
Intervention Used
I entered room 449 to see Suzy sitting on her daughter’s bed. Her daughter was admitted to the hospital the night before, but only after spending the day in the emergency room. My purpose in going to visit this room was to discuss with Suzy some information she recorded on the patient history form. Suzy looked drained. We visited at first then I explain the purpose of my visit. I invited her to join me in another room. She declined saying she was comfortable talking in the room with her daughter there. I told her we noticed she had marked abuse on the history, then asked her what type of abuse it had been. She replied it had been sexual abuse. I asked if it had been reported. It had. I inquired if there was still contact with the individual, the response was no. I then explained to her that the only reason I asked was to make sure she and her family were safe. The woman then told me more of their life story. She did disclose that at the time she found out who had hurt her daughter, she was already pregnant his child. She gave that baby up for adoption. She and her husband were currently unemployed. She had received a job at a local store but needed transportation. She bought a used truck. Before she was able to start work, it broke down. They did not have the money to repair it. Now their daughter was in the hospital very sick. The hardships went on and on.
Suzy then
said, every time she tried to improve her life, something got in the way. She felt she was stuck but was trying not to
let herself feel depressed over their situation. She repeated over and over that she needed to
be strong for her children and not let herself feel down. I explained to Suzy that I could see she was trying
to better her life and trying to do what is best for her children yet it is
normal for people to feel upset, or down when their child is sick in the
hospital, they can’t find employment, etc.
Assessment
This intervention went well as I was able to identify specific things she was doing that anyone would feel if they were in her situation. This woman was feeling stressed that she not become depressed over their situation. So I wanted to presented validate and present her feelings as normal and understandable. My purpose in doing so was that she understand she was not “going crazy” because of her feelings. I was also able to pair universalization with encouragement in this situation.
3. Behavioral Contract with Sandy
Overview
Behavioral contracting is creating
an agreement, or contract between 2 or more individuals. The contract specifies what behaviors will
occur and what will be the consequence for accomplishing that goal. In contingency contracting, is when one
person commits to reward a certain behavior from the other person. Reciprocal behavioral contracting is when
both agree to reward each other when certain behaviors are performed. In my example below, I used a contingency
contract.
Need Addressed
Sandy struggles to cook and eat real meals. She does not like cooking for herself. Instead she only snacks. Sandy is involved in rigorous physical activities and needs to be eating good meals.
Intervention Used
On Sunday evening I went to check on my group
of students. Sandy was excited to see
me. She told me I should bring her a
pecan pie because Monday was her birthday.
I laughed and said, I would think about it. As I spoke with one of the staff who had been
working with Sandy for the week, he told me they could not get her to eat real
food. Sandy was new at Aspiro and was
not interested in learning or cooking her own food. Her not eating well was becoming a
problem. Plus, she would not learn to
cook her own food if she would not even try.
This inspired me. I quickly
devised a plan, explained it to the staff who in turn supported the idea then
went to speak with Sandy again.
I asked Sandy about her eating and cooking habits. She admitted she was not cooking food to eat. We then discussed the importance of her learning to cook her own food and eating real meals, not just snacks. I asked her how could I justify bringing her a pie for her birthday if she was not able to eat healthier food and take care of herself? I then proposed to her that if she made the next 4 meals and ate them, I would bring her a pie. We defined what a meal was and which staff member I would call on Monday night to see if I should bring her a pecan pie for her birthday. She agreed, saying she would do anything for a pecan pie. She said she would make and eat the next 4 meals. And if not, I would not bring her a pie. This was our contract.
Assessment
This intervention worked well because I utilized something she wanted and created a way for her to achieve the goal. It would need Sandy to push herself outside of her comfort zone but it was something I knew she could do and had people there who could also assist her in accomplishing this task. In the future though, I will present it in a way that she feels like she is a part of creating the conditions and stipulations for the contract. The way I presented it could cause her to feel that it was my goal and not really her goal. Next time, I will also have her repeat by the conditions and what we had defined a meal as, to eliminate any possibility of a misunderstanding of the contract. It will help to eliminate excuses and give her full responsibility for the outcome.
4. Information to a Mom That Turned Into Advice
Overview
When giving information, as a social worker we provide information to a client so they can make a decision or do a task. As a social worker, we do not give advice as we do not know what is right for them. We may see the consequences and we can inform them of the consequences, however, we do not know what is best for them. In addition, most often when clients ask for advice, they are really are asking for information.
When giving information we present it as facts. We also present the consequences as facts. Then we give resources and give referrals. This allows them to make the best decision. When they insist on knowing what to do, a social worker can tell them what others have done and what I have seen.
Need Addressed
A mother needed help when her child was in the hospital to know what to do with her other children. She did not want to accept the help offered to her by others for fear that her kids would get theirs sick.
Intervention Used
I entered the hospital room of a sick infant to make sure the family had the support they needed. As I visited with the mother she explained the stress she felt as her husband missed work to stay home with their other child who was also sick. The next day, the father was going to have to miss work if the child not in the hospital was still sick. I asked if there was anyone who could help watch this child such as a family member or friend. The mother explained that multiple people had offered but she did not want to accept their offer because they had children. I told she needed to accept help because those people who had offered to help knew her child was sick and understood the risk. It was their choice to offer and she would be less stressed if she would accept help from others.
Assessment
I told this mother that if others offer then she should accept. This advice was more condemning for her not being able to accept help from others than information of the reality of the situation. The way I presented what I said was as advice. As a result, the mother became resistant to talking with me. Instead I should have used reality theory and presented the information by asking her thought provoking questions such as, “Do you realize others desire to help you?” “What will happen if your husband misses work again?” “Are there any other options?”
Overview
Homework is used to help learn new behaviors by practice. It is important to have a purpose for the homework, make sure the assignments are realistic and achievable, and that the assignments are beginning where the client is at.
Various activities and assignments can be used as homework. For homework to be most effective and manageable for the client, it helps to write it down and have clear instructions. In my example below I gave my client a “do” statement. This means, it was something she needed to “do.” Other types of assignments are ones where they do something a certain amount of time (quantity statements), something they record after they do it (recording statements), something they bring to their next session (bring statements) and contingency statements which are if, then type assignments (If you…then you…).
Need Addressed
Carlie wanted a public health nurse to come help her but stress that she did not know what to ask. The purpose of the homework assignment was to minimize Carlie’s stress and prepare her to remember the questions she had for the public health nurse. In doing so, Carlie was also learning to help herself.
Intervention Used
I sat in Carlie’s room the day after she had delivered her baby filling out a referral for a public health nurse to come check on her and the baby’s and answer questions she had after they returned home. At age 16, Carlie was a single, extra nervous new mother. Before leaving, I gave Carlie a homework assignment. She was to keep a notepad on the kitchen counter or in the bathroom or by the bedside with a pen. I explained to her that as she began caring for the baby outside of the hospital more than likely she would have questions and concerns. When she thought of a question she had for the nurse she was to write it down. When the nurse came to visit she would be able to have her questions answered and her concerns met.
Assessment
This homework assignment was good because it was simple yet beneficial to her. One difficulty was that there was no way for me to follow up with her on the assignment because she was leaving the hospital the next day. Also, in the future, it might be helpful if I had an inexpensive little notebook to give to her as a gift for her to write her questions and concerns to ask the nurse in.
