Case Study Reflection #9 Beat

Case Study Reflection #9
Beatrice Turner
Interventions 520E
Professor Dinger
University at Buffalo
September 20, 2010

Social workers will face numerous ethical dilemmas throughout their professional career. At times, a social worker will need guidance and support to direct them down an appropriate path when working with clients. Social workers must rely on several resources to assist with this determination, such as colleagues’ suggestions, supervisory council, professional experience, educational background, and particularly, the National Association of Social Workers’ (NASW) Code of Ethics.
According to NASW, social workers are to consider all values, principles, and standards in NASW’s Code of Ethics in making comprehensive ethical judgments. NASW’s Code of Ethics further states that the main responsibility of all social workers is to “promote the well being of clients” (National Association of Social Workers [NASW], 2008, ethical standards). A client’s well being includes, but is not limited to, physical, cognitive, emotional, social and spiritual well being (Walsh, 2009, pp. 7-8).
The case study “Una Rosa” presents many ethical dilemmas faced by the case worker in which he had to rely on both NASW’s Code of Ethics and his personal and professional judgment. The case worker’s management may have been flawed by his failure to share with the client, Rose, his concern that she did not sufficiently deal with her trauma. Based on professional experience, education and interpretation of NASW’s Code of Ethics, this writer believes the case worker was bound to at least inquire as to Rose’s coping skills in the matter of the trauma she received when she was raped, watched her sister being raped, and watched both her parents being murdered. Rose had attempted to commit suicide because emotions she had suppressed were now coming to the forefront when she became romantically involved with a man from church. Rose had not suffered any other mental breakdowns before this relationship began and it stands to reason that Rose could suffer another breakdown if she does not adequately deal with her trauma.
The case worker assisted Rose in becoming connected with many community agencies and attending events which appeared to assist her with coping skills; however, it remains uncertain whether or not she has worked through her traumas sufficiently to prevent them from resurfacing again. Any type of damage to the psyche as a result of a traumatic situation can result in many physical alterations to the brain and the brain’s chemistry. This damage can hinder one’s ability to appropriately cope with the trauma and any supplementary emotions (Bell, Kulkarni & Dalton, 2003). Moreover, Purnell (2010) has suggested that ignoring or not dealing with a traumatic event, also known as dismissive trauma, can lead to more severe trauma. The case worker, therefore, was responsible for sharing his concern and ascertaining what the client wanted to do. If Rose had wanted to delve into coping strategies and the case worker was not specially trained in this area, he should have provided referrals to other programs that could have assisted her, as required by NASW’s Code of Ethics: commitment to clients, self determination, and competence (NASW, 2008, Code of Ethics). In addition, by neglecting to share his concerns about Rose’s inadequate recovery from her trauma, the case worker is at risk for vicarious trauma. According to Bell, Kulkarni & Dalton (2003), severe emotional trauma is potentially contagious and can be transferred to the case worker through the practice of empathy. Vicarious trauma can then lead to professional burn-out.
Another area posing an ethical dispute in this case study is the termination process the case worker conducted with Rose. Professional experience would suggest that there should have been a more gradual termination plan to allow for a smoother transition to the elimination of services. Miley, O’Melia & DuBois (2009) explains the termination process as one that reviews progress made by the client, sets future goals for the client to continue working on, continues to encourage through client self-direction, and includes a period of feedback for the case worker to use for professional development. The case worker in this case study did not create and/or complete a termination plan, and therefore, was not able to gain insight into his future skills.
If the there had been an appropriate and well timed termination process, perhaps the case worker would not have been faced with what may have been his biggest ethical dilemma in this case, which was Rose’s request to be friends. The NASW’s Code of Ethics as well as professional experience suggests the case worker’s willingness to enter a friendship with Rose, and his meeting with her at a coffee shop for several months after the case was closed, crossed professional boundaries and put him in violation of the NASW’s Code of Ethics. NASW’s Code of Ethics clearly states that a social worker is not to engage in dual relationships and/or take advantage of any professional relationship that furthers one’s personal interests (NASW, 2008, Code of Ethics). It is the case worker’s responsibility to uphold higher ethical standards than those of the client, and when a case worker engages in a relationship other than a professional one, it can potentially compromise the professional relationship. The client can become dependent on the case worker and thus fail to move ahead and become self-sufficient. In this case, the case worker moved back to America after his stunt in Guatemala, and he could no longer carry on the same friendly relationship he had with Rose. This was not fair to Rose and it had the potential to cause Rose’s trauma to resurface, as the case worker appeared to provide a coping method for Rose.
On the other hand, there are many other factors that play a role in the case worker’s decisions. The case worker cited NASW’s Code of Ethics adding that he had to make a decision based on his geographical location, the culture of the land, and this particular client. The case worker was a student, temporarily living in a third world country with extremely violent paramilitary activity, he was immersed in a culture and environment that he was unfamiliar with, and he encountered scenarios that the NASW Code of Ethics did not explicitly discuss. NASW’s Code of Ethics was designed as a tool to provide general principles intended to offer guidance in making decisions (Shulman, 2009); the case worker had to make instantaneous decisions using his education, experience, intuition and personal values as well.
This writer believes the case worker would evaluate his practice in the case as: appropriate with room for growth. The case worker appeared knowledgeable in the social work arena and used many approaches, such as empowerment, strengths-based and multilevel systems. He was in a land unfamiliar to him and he quickly adapted, learned the resources in the area, and used this information to better assist his client. He had to make some tough decisions; however, he appeared to have thought them out and ultimately used his best judgment.
An intervention that the case worker could have initiated on a macro level to bring forth change for mental health services in the community is the battle for social justice. This writer believes the case worker could have gotten professionally, politically and personally involved with some of the organizations in the community, such as those that Rose became involved with, to bring forth change and/or modification to the principles that govern the current programs and land. NASW’s Code of Ethics states that social workers must advance knowledge and understanding of oppression and diversity, and are required to do their utmost to provide individuals with much needed information, resources and services (NASW, 2008, Code of Ethics). The case worker could have achieved this in Guatemala or even the United States upon his return.
This writer realized some similarities and differences from this case to this writer’s field education placement. Lackawanna Drug Court, like the agency in which the case worker worked in “Una Rosa,” provides case management and counseling to individuals, including referrals, linkage, advocacy and follow-up. Rose was dealing with a traumatic series of events that caused psychological trauma. Based on the individuals served at Lackawanna Drug Court, this writer believes that many substance and alcohol abusers have also experienced some form of trauma that has caused them to cope with the use of alcohol and/or drugs. In addition, where the case worker used multi-level systems, empowerment and strengths based approaches to serve his client; this writer will also need to utilize these approaches. Some potential differences are that clients served in Lackawanna Drug Court are mandated by the criminal court system to participate in services, and the clients here most likely have not experienced the same cultural oppression as the individuals in Guatemala, such as the violent paramilitary activity.
There are many things this writer has learned from this case study. For example, this writer will be more self-aware when it comes to professional boundaries and will spend more time listening to the needs of the client. This writer understands that not all cases are similar and that social workers have to trust in their judgment, education and experience to guide them. At times, there will be contradictions between what the social worker believes is best and what the NASW’s Code of Ethics advises social workers to do. Believing in the mission of social work, truly assisting clients to the best of one’s ability in relation to one’s education, experience and intuition, as well as a commitment to continued learning, is the best place to start.

References
Bell, H., Kulkarni, S. & Dalton, L. (2003). Organizational prevention of vicarious trauma.
Families in Society-The Journal of Contemporary Human Services, 84(4), 463-470.
Retrieved from http://new.vawnet.org/Assoc_Files_VAWnet/PrevVicariousTrauma.pdf

Purnell, C. (2010). Childhood trauma and adult attachment. Healthcare Counseling and
Psychotherapy Journal, 10(2), 1-7. Retrieved from http://www.iasa-dmm.org/images/
uploads/Attachment%20and%20trauma,%20Purnell,%202010.pdf

Rivas, R. & Hull, G., Jr. (2004). Case studies in generalist practice (3rd Ed.).
Belmont, CA: Brooks/Cole.

Shulman, L. (2009). The skills of helping individuals, families, groups and communities (6th
Ed.). Belmont, CA: Brooks/Cole.

Walsh, J. (2009). Generalist Social Work Practice: Intervention Methods. Belmont, CA:
Brooks/Cole.