A Case Approach to Psychosocial Therapy

2013-10-28

　

 A Case Approach to Psychosocial Therapy

 

Abstract:

It is focus on the application of psychosocial therapy on a case of a troubled boy with some social functioning problems. The writer ever did the field work in a school in Pudong district, Shanghai where I engaged the case.

 

Keywords: psychosocial therapy   social work   non-reflective   reflective discussion

 

 

Psychosocial therapy is a traditional method in social work. “Psychosocial” was first used by Frank Hank in 1930s’. One of the most important works is “Casework: a psychosocial therapy” by Woods, M. E. & Hollis, F. Different theories, such as psycho-analytic theory, ego psychology, role theory, learning theory and systems theory have great effects on it.

 

In the circumstance, experience in the childhood, interpersonal relationship and self-realization are therapeutic features. Non-reflective and reflective discussion are often applied in the process of engagement and intervention. Information collection, diagnosis and evaluation also play an important role in the therapy. Besides, the therapy pays attention to significant others and collaterals, that is the interaction between environment and individual.

 

Initial session

The client was studying in a junior high school in Pudong District, Shanghai where I did my field work as a school social worker during my schooldays in the university. [1]He was referred to me by one of his teacher, Mrs. Wang from whom I learnt that the client is the offspring of a couple of ‘Zhi Qing’.[2] His parents are living a hand-to-mouth existence in Anhui Province with little literacy. They always blame the client for what he has done by the means of beating. The client, Haichao(anonym), 15 years old, the only child of the couple is now living with his uncle in Shanghai. The uncle is a worker in a factory and works in a bar as a waiter at part-time.

 

Haichao came to Shanghai three years ago and was soon attracted by the ‘wonderful’ life here. He was always wandering about with the classmates after school. And then he wandered off the track, had many false friends for company in the community where he was living, and tyrannized in the school. He picked violent quarrels and tyrannized over the weak, which was to be the goal of his life. He seemed to be an overlord that no body would resist him. Whenever he did immoral things and offended rules in school, he was smart to disguise the fact. And he is an open-minded student with good speech craft and good achievement in study.

 

The applicant looks short and rather thin with colored hair. He always pleaded he did nothing wrong in justification of his conduct at the beginning of the first meeting. Transference can be easily caused from teachers to social workers—that is to say, authority and punishment giver teachers are thought to be will reflect on the social worker, not to mention the fact that the teachers are appointed to be the social workers by the local government. The applicant came to see the social worker with defensive and resistance ineluctably. The initial session focused on easing his anxiety and creating a relationship based on trust.

 

The applicant knew that he was taking risks being expelled from school at any moment. He was a student of Junior Three and would left school next year. And only the schools like technical secondary school would accept him, which bothered him a lot, because he wants to pursue his study abroad some day in the future. If he kept that situation, his dream would not come true. So the applicant hope for the help of the social worker to change prejudices the most teachers conceive while he kept insisting that he should not get any help from the social worker and he was compelled to come here.

 

Firstly, the social worker couldn’t make any promise indiscreetly in order to get trust rapidly from the applicant. Since the social worker hadn’t had a good command of his facts, I tried to know more about him and create a relationship by means of sustentation and grope- depiction- release.

 

Understanding and admission would comfort the applicant. The social worker listened respectfully to what the applicant said, which made him talk about his experience and feeling with an open mind. This kind of encouraging atmosphere eased his defensive.

 

The social worker learned from the applicant that he got a mark made against his record for misconduct at junior two. Later, he schemed a brawl because a student in another class is an offence to his eye. After then, he told a lie that he just looked on but not involved in. So he got another mark for punishment instead of being expelled from school. The applicant found it important to speak rather than get himself involved in fighting. He schemed several brawls in and off campus from then on, which helped him win the publicity. Although the teachers ever exposed his misconduct, his entourage was always made a scapegoat. That is the reason why his accompaniers didn’t trust him any more.

 

Catharsis helped the applicant to release strong feelings. He had never talk about details of his experience and feelings to others before. Admission and non-criticism encouraged the applicant to confront with his feelings and to plan for the destiny.

 

However, there’s still some doubt for the applicant about the role of the social worker. For instance, whenever he revealed his intense emotion, he often asked the social worker how to deal with his problem with doubtful expression in the eyes. He repeated he just came here for curiosity and purely wanted to look for someone to chat with. He also said he looked down on those who need help. So it’s necessary for the social worker to remove the applicant’s anxiety by reflective discussion. The social worker was willing to talk about the incompatible feeling of him, to explain the different role of social worker as well as to be accountable for confidentiality. Furthermore, I suggest carrying out an experimental period and I was glad to be his talking target. Thus, the client had an active attitude towards the process of the therapy.

 

Diagnosis

“In circumstance” emphasizes relationship and interaction between individual and social system such as family, friends, schools and work place. After creating relationship based on trust, the social worker helped the client describe his family, friends and experience in childhood to know more about the interaction between him and these systems.

 

He grew with poverty and suffering. Probably it’s the reason that he looked down on those who need help. He thought his parents are eager for help in a sorry state. He wanted to get out of the state and get ahead in life. His behavior happened to be good for the inferiority complex. Furthermore, his accompaniers and position of leader in the group would protect him, which met his bilateral needs.

 

The client’s superego was so weak that there was no inner moral standard inside him. He paid little attention to the consequences of what he had done, because he always used defense mechanism such as denial and rationalization to defend himself at pressure. What the client said above indicated the reason why he could get away from the brawls in and off campus was that he betrayed his friends. So he had no friends without stint. Besides, most teachers in the school are discontented with him. It looked as if he won little social support from the system of friends and school.

 

Psychosocial therapy also insists environment has effect on human beings and vice versa. Although the client’s elder uncle is very fond of him, the uncle has to do the part-time job in the evening, leaving on the early morning. The client always wanders about outside without system of supporting. He has reached the self-development stage. Since he lacks right education of parents and his uncle doesn’t seem to be a good sample, it is easy to be hungry for recognition of the forces of evil, which provides him with safety and goals in life. Those false friends would help him whenever he was bullied.

 

On the whole, according to the information from psychosocial observation, a conclusion could be drew that the client was in a weak system of family, community full of force of evil and friends without emotion.

 

Psychosocial therapy also estimates the client’s advantage. He wants to study abroad. He is a person with a natural gift of willpower and learning. Moreover, his uncle and the teacher referred him to the social worker care for him. So there will be a lot of capabilities to develop.

 

Besides，we arranged the time and place of the meeting every week. As to his family and friends, the social worker should get the client’s agreement to avoid undesirable effects, which is one of the most important steps in the psychosocial therapy.

 

Therapeutic purposes

(1)   To ease the client’s upset. Creating relationship based on trust by sustentation and grope- depiction- release to make him involved in the process of therapy.

(2)   To adjust the function “in circumstance”. For example, keeping away from false friends. Improving the understanding of the teachers and uncle’s care.

(3)   To provide the client with the legal way to realize his fuller potential and to help him learn how to distinguish right from wrong; to control his emotion and instinctual impulses.

(4)   If possible, to remove from the community to change the side effect of the environment on the client

 

Skills in intervention

To create relationship based on trust by means of sustentation and grope- depiction- release has been used in initial session.

 

The client’s friends were expelled from school for breaking the school regulations. Since there is no school giving admission to them, they have to work in a restaurant as waiters. The social worker helped the client to make self-questioning by reflective discussion. He didn’t seem to be aware of his problems. As a mater of fact, what he had done ran counter to his inclination. The social worker tried to induce the self-reflection by questions instead of explanation. The social worker asked:

 “What about your friends- Wang Qun and Zhao Fan (anonym) after leaving the school?”

“You mean you would lose the opportunity for further study, don’t you?”

“Since you want to study abroad, do you know the requirement for that?”

 

When the client had a little self-questioning, the social worker helped him produce external reaction by “others, health and situation” to change his erroneous ideas. His misconduct wasn’t worth admiration from which he would not stand out.

 

The client often avoided facing his own problems with denial and rationalization. It was necessary for him to have somewhat a sense of guilt. So the social worker discussed it with him after creating relationship. The client needed to square up to his behavior from which he learned how to regard others’ needs and self-control. His pattern of behavior was to protect himself form being punished by making a scapegoat, which was not fair to his friends and would change them into enemies. The social worker helped him discover his pattern and improve interpersonal relation. I asked:” you always insist personal loyalty. When what you did was exposed, you were defending yourself. Do you think of that?” After the client realized his pattern, he had to seek for the source of the problem and the way to change it.

 

The relation between the client and his entourage is still important for him. It was difficult to be quite out of touch with them. But the client wanted to keep away from them, which would be dealt with by emphasis. It was up to his self-determination.

 

It was the time to end my field work, so I had to refer the case to the social worker works in the school. Since the client was familiar with her, he didn’t mind the referral.

 

There are a lot to do about the environment. It’s important to change the system of family, resident environment and friends. The significant others-the client’s uncle didn’t know what happened to him. He should give more care to the client. The social worker also should try to change the collaterals- teachers’ thoughts. To let them know the origin of his problems and share the clients’ needs and difficulties. (If the client agrees with that).

 

Discussion and summary

Psychosocial therapy is helpful to resistible client. The social worker didn’t give immediate unpractical promise to get the trust of Haochao. But to ease the upset by an experimental period and to clarify professional relationship. It’s necessary to consider intrapersonal feelings.

 

Direct effect, including five levels, can be put into use in different situation according to dissimilar clients such as troubled youth, sot and elder abuse.

 

Environmental work is very important besides intrapersonal feelings. It will not work until the environment in the community is changed. Improvement of his brother’s care and attitude of the teachers also play a key role.

 

School social work is an experimental unit in Pudong district, Shanghai. Since the teachers in the school are appointed to be social workers, it will be more difficult to deal with their roles. And it is crucial to clarify professional relationship.

 

Reference

1.     古学斌，阮曾媛琪：《本土中国社会工作的研究、实践与反思》.P98-131社会科学文献出版社.2004

2.     钱宁：《中国社会工作教育发展面临的机遇与挑战》.《社会》.2003(06)

3.     宋宪东，乐蕴韬，张洁，丁晶，郭树宝：《浦东新区开展学校社会工作的研究报告》.2003.8

4.     文军:《略论学校社会工作》.《社会》.2003（01）