Case Study:
Pat is a social worker who provides individual and group treatment in a partial hospitalization setting of a community mental health center. She has 10 years of experience in clinical social work, and she considers herself a specialist in trauma-focused work. For the past several years she has had a caseload heavy with clients who have suffered multiple traumas. Her days (which generally are long) usually consist of group therapy sessions, scheduled individual appointments, and tending to crises that arise from her client caseload.
One of her clients, Morgan, age 22, has been in both group and individual treatment with Pat and at the agency for several years. Morgan was physically abused as a child and sexually abused by multiple perpetrators for most of her childhood and teen years. She has been diagnosed with post-traumatic stress disorder (PTSD) and depression. She is triggered easily and experiences intense flashbacks that include auditory, tactile, and visual memories.
She needs a great deal of assistance to reorient and experiences increased intensity and frequency of flashbacks when uncovering and processing new or extreme trauma memories. The treatment team notes that Morgan does better and feels safer when she has a predictable structure and a clear under- standing of her role and others' expectations of her participation and when the team members maintain good boundaries and work within well-defined roles and parameters.
In the last several weeks, the team has noticed that Morgan has appeared to lose ground; she has been more tearful, lethargic, and less interactive and has been experiencing one or more flashbacks daily. During an informal debriefing the team engages in while writing progress notes at the end of the day, Pat shares that Morgan has needed her support more in the past couple of weeks. She shares that Morgan has called her after hours almost daily-so much so that Pat has worked out a special arrangement with the after-hours call service and with Morgan so that they can be quickly connected. She has assessed this arrangement to be working because Morgan has been calling her more frequently, sometimes twice in an evening, when she needs support. On days that Pat and Morgan have individual counseling, Pat sometimes sends Morgan a text of support at the end of the work day (around 6 or 7 pm) to remind her that Pat is there for support if it is needed. Pat says that Morgan seems to appreciate this, because she has begun to bring her a small gift each time they meet. Pat has designated a shelf in her office for Morgan's gifts. Pat is very pleased that they have formed such a strong connection, similar to a parent-child bond, because she feels this will improve their work together.
She is aware that cognitive-behavioral therapy (CBT) (the agency's preferred approach) has evidentiary support but sees the success of this case as anecdotal support for continuing her work as she always has. She also says that the comments she receives on Facebook about her work with previous clients also confirm she is on the right track.
She states that she has decided to document Morgan's individual sessions only in general terms to provide her with safety during her work.
During end-of-the-day wrap-ups, staff members read and respond to the journal entries that clients are asked to write at the close of each treatment day. The procedure at the agency is for the team to rotate which member responds to clients throughout the week. Jim, a team member, picks up Morgan's journal to read and comment. He sees that all staff entries made in the last 3 weeks were made by Pat. In the comments, she often reminds Morgan of how special she is and how much Pat cares about her and her progress. While he is reading the journal, Pat suggests they consider arranging a weekend camping trip for staff and clients, thinking this would be a good grounding and relationship-building activity. She shares that she has mentioned this to Morgan and proposed it as a corrective family activity.
In his supervision appointment, Jim shares the above information with the supervisor.
1. Using the NASW Code of Ethics, identify the salient professional and ethical issues present in this case
2. Make a professional development plan for this social worker. Need Assignment Help?
3. What are the professional boundaries, limits of confidentiality, and the duty to warn in this case?
4. Make a remedial plan through which the social worker can correct problem behavior and develop an ongoing plan of professional development to sustain the positive change in this case and help avoid such pitfalls in the future.