Tensions between rules, regulations and clinical work:
The regulations governing the STCF have a profound impact on my clinical work with clients. Engagement and alliance formation is quite difficult because clients are mandated for treatment. There are many obstacles attempting to establish a therapeutic alliance with clients who are involuntarily committed. The intrapsychic and interpersonal dimensions are filled with a variety of conflicts. The level of acuity on a unit with involuntarily committed individuals is very high. The intrapsychic conflicts include suicidal or homicidal ideations and psychosis. interpersonal dimensions include engaging with clients who are resistant to treatment and feel they are being “forced” to be hospitalized …show more content…
Involuntary clients are often resistant to treatment and the level of trust between the psychiatrist and client seems tenuous at best. The necessity of commitment hearings creates an additional obstacle to clinical work. Several patients have “flipped out” and needed medical restraints after receiving a status of continued commitment from the judge. Sheehan &
Burns (2011) during a study showed that there was a positive correlation between inpatient clients’ perception of coercion and the quality of the therapeutic relationship. Clients who felt coerced into receiving treatment negatively rated their relationship with clinicians. The legal status of a client being either voluntary or involuntary did not have a greater impact on a client’s rating of the therapeutic relationship. Yet the courtroom hearing experience possibly causes clients’ feelings of coercion to increase thus negatively affecting the therapeutic alliance. These regulatory procedures affect the clinical relationship.
Managed care constraints also have an impact on my clinical work. “Length of stay
(LOS)” or how many days patients remain in the hospital is an important factor that drives the short-term care model. The STCF has to limit its average length of stay due to …show more content…
I often return to the concept of functionalism in my work. My role and function as a social worker within the STCF setting is clinical case management and recognizing that function allows me to reconcile the clinical, ethical and legal tensions.
Clinical Relationship:
Therapeutic Alliance:
The quality of the alliance between me and Peter is good. I have had at least six individual sessions with him. We also interacted within group settings and treatment team meetings. I believe we had a good working alliance. We never addressed the issue of cultural transference or cultural countertransference. Cultural transference is the transference experienced by a client when engaged with a therapist of a different ethnicity or culture (Shorter-Gooden &
Jackson 2000). Peter is a white male and I am black male. This racial dynamic has probably influenced our work together but because my function as a social worker is crisis intervention I decided that it was not appropriate to discuss this issue with a client who doesn’t have much ego strength and is also involuntarily committed. Maintaining a working therapeutic alliance
The regulations governing the STCF have a profound impact on my clinical work with clients. Engagement and alliance formation is quite difficult because clients are mandated for treatment. There are many obstacles attempting to establish a therapeutic alliance with clients who are involuntarily committed. The intrapsychic and interpersonal dimensions are filled with a variety of conflicts. The level of acuity on a unit with involuntarily committed individuals is very high. The intrapsychic conflicts include suicidal or homicidal ideations and psychosis. interpersonal dimensions include engaging with clients who are resistant to treatment and feel they are being “forced” to be hospitalized …show more content…
Involuntary clients are often resistant to treatment and the level of trust between the psychiatrist and client seems tenuous at best. The necessity of commitment hearings creates an additional obstacle to clinical work. Several patients have “flipped out” and needed medical restraints after receiving a status of continued commitment from the judge. Sheehan &
Burns (2011) during a study showed that there was a positive correlation between inpatient clients’ perception of coercion and the quality of the therapeutic relationship. Clients who felt coerced into receiving treatment negatively rated their relationship with clinicians. The legal status of a client being either voluntary or involuntary did not have a greater impact on a client’s rating of the therapeutic relationship. Yet the courtroom hearing experience possibly causes clients’ feelings of coercion to increase thus negatively affecting the therapeutic alliance. These regulatory procedures affect the clinical relationship.
Managed care constraints also have an impact on my clinical work. “Length of stay
(LOS)” or how many days patients remain in the hospital is an important factor that drives the short-term care model. The STCF has to limit its average length of stay due to …show more content…
I often return to the concept of functionalism in my work. My role and function as a social worker within the STCF setting is clinical case management and recognizing that function allows me to reconcile the clinical, ethical and legal tensions.
Clinical Relationship:
Therapeutic Alliance:
The quality of the alliance between me and Peter is good. I have had at least six individual sessions with him. We also interacted within group settings and treatment team meetings. I believe we had a good working alliance. We never addressed the issue of cultural transference or cultural countertransference. Cultural transference is the transference experienced by a client when engaged with a therapist of a different ethnicity or culture (Shorter-Gooden &
Jackson 2000). Peter is a white male and I am black male. This racial dynamic has probably influenced our work together but because my function as a social worker is crisis intervention I decided that it was not appropriate to discuss this issue with a client who doesn’t have much ego strength and is also involuntarily committed. Maintaining a working therapeutic alliance