MethodsAssignment
- 1. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 1 Methods of Intervention HMNS 10097 Stages of Change Assignment Christopher Maxwell
- 2. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 2 Section 1 Case Study Mary is a 50-year-old Caucasian woman who has been struggling with alcohol addiction for almost 15 years. Growing up, Mary’s childhood was difficult. She was abandoned by her birth father and raped by her step father. During young adult hood, Mary was beginning to find success. She had a good position at the RBC bank in downtown Hamilton when health complications started. She was diagnosed with Crohn’s disease which forced her to quit her job. Difficulties in health also caused her to have a miscarriage. Relying on her husband’s income was difficult as well because he also was in some addictions trouble, and the marriage was going through rough times. As a way to make ends meet, Mary started working at the local bar under the table because it did not effect her ODSP income and she did not have to work a rigorous schedule, so she could work around her health problems. This quickly led to Mary staying late after work to grab a drink, making her weekends about having drinks at home and ultimately, caused major problems in her marriage. One night, Mary mixed her medication with alcohol and ended up getting drunk to a point that she left the bar with another man that she mistook for her husband. Her husband knew where the guy she left with lived, and showed up to the house just in time before she was forced into sex with random strangers. This caused a falling out in the marriage, where the two mutually agreed that things were only getting more toxic between each other. All the while, her son has seen all of this and had to live through it during his adolescent years. Mary and her son live together, in a run down triplex house. Her son has stated that it would be very helpful that they try and move out to start anew.
- 3. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 3 Today, Mary has taken steps to conquer her alcoholism, but is still struggling. When health problems flare up, or money issues become more urgent, it causes Mary to rely on drinking to try and numb the pain and stress. With her 21 year old son’s support, she does want to make the change. She understands it’s a threat to her health to continue drinking and she understands that drinking does not help anything, and that it only makes things harder. The interview can be found in the appendix. Problem Mary cannot break her addiction to alcohol. She has attempted rehabilitation methods many times but feels she is in need of more external help from a social worker. In addition, she is unable to gain any extra financial income which makes moving out difficult for her and trying to support her son through school nearly impossible, which adds to the stress and causes her to drink more. Section 2 Stages of Change Mary is currently in the preparation stage, although she has cycled through all of the stages many times. Mary displays eagerness to make change, she addresses her issues and she speaks confidently about success and handles her failed attempts at achieving soberness. The preparation stage is defined as “people have made a commitment to make a change. Their motivation for changing is reflected by statements such as: “I’ve got to do something about this — this is serious. Something has to change. What can I do?” This is sort of a research phase: people are now taking small steps toward cessation. They are trying to gather information
- 4. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 4 (sometimes by reading things like this) about what they will need to do to change their behavior.” (Volz, 2009). I believe that Mary has progressed through the precontemplation stage and the contemplation stage as she has acknowledged that her problem behaviour needs to be changed and her ambivalence towards the issue is gone as well. I would even argue that Mary has started to work on tasks under the Action stage as she is starting to take larger steps towards correcting behaviour. She is not quite there yet because she still needs to work on creating a concrete plan to follow, but she is progressing well. She understands that her addiction problem has multiple aspects that are affecting her life and that she has to tackle one issue at a time in order to make progress. Mary can successfully move into the Action stage if she continues to consciously make progress the way she has. She should also be meeting with myself regularly, working with other counsellors and taking advantage of opportunities in the community. She has expressed a dislike towards rehabilitation centres and prefers to avoid Alcoholics Anonymous so the big step we have to work on is changing her attitude towards those resources or finding effective alternatives. Once she can understand that she just has to let the system help her, she will be able to truly graduate into the Action stage, but as of now she is still displaying signs of uncertainty towards these programs. However, Mary is eager to work with new resources and guidance provided to her and she displays a need for less structured programs. As mentioned, Mary understands that she cannot overload herself by trying to handle all of the problems that alcoholism has caused her at once. An explanation of Domain Specificity will help further her understanding of the multiple issues drinking has caused her.
- 5. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 5 Section 3 Definition of Strengths Based Model The Strengths Based Model is a model in which Social Service/Social Workers are starting to use as a new way to present information and work with problem behaviour. It works from a perspective that highlights strengths and encourages clients to work with their positives rather than trying to focus on their negatives. For example: a client is able to work well alone but can’t handle the idea of groups. Rather than traditional social work models which would focus on the idea that this client is antisocial and needs to be ‘fixed’, Strengths Based would look at this client’s ability to work well independently and try to build success off that. Problem behaviours and challenges are considered obstacles that can be overcome, rather than a focal point. When traditional social work focuses so hard and precise on troubled behaviour, generally that behaviour is created into a bigger issue than it actually is. The Strengths Based Model works in a cycle (Hammond, Zimmerman, 2014), as it passively works on issues because it focuses actively on building strengths into even greater assets and does not bring attention to the weaknesses. Personal Strengths Firstly, Mary has some tremendous personal strengths. Having a history with this behaviour, she has developed a great sense of self-awareness. Mary is able to identify her emotions and take responsibility for her mistakes when she is required to. Mary also is able to communicate effectively with others, showing that she can sort her emotions and articulate her true feelings. She is able to comfortably talk about anything which makes working with her smooth. Even when she feels like she has encountered issues on her path to recovery, she is able to push through her phases of depression with her supports.
- 6. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 6 Environmental Strengths Mary uses most of her environmental strengths effectively. She reports to counsellors, does active research and does her best to take feedback from all sources. She also does a good job of staying active in the community. Even if its not related to solving her drinking behaviour, Mary keeps herself busy by shopping and spending time with friends and family. Mary has a close relationship with her mother. Mary had a brother who passed away from a drug overdose, but she was always close with him and their mother. Now, she confides in her mother and looks to her for support and guidance as this issue has effected her family before. Mary’s ability to put her faith into people is a good sign that she does not feel alone and understands it is okay to ask for help. Often, she volunteers at her mother’s retirement building to keep busy by building relationships with the residents and giving herself purpose. Personal Obstacles Mary’s personal obstacles are few but powerful. Mary has bouts of depression and health issues. Mary has had some major surgeries in her life and she lives with Crohn’s disease, so day to day life on a physical level can either be really good or terrible. On those terrible days, it proves very difficult for Mary to continue on as the positive spirited person she is. Usually when her health issues flare up, so does her depression. Mary falls completely victim to her body shutting down and working against her which drives her away from her ability to sort her emotions and work with her mental processes. These two powerful obstacles are almost unavoidable. Mary understands that she has to do everything she can to push through these situations and not give up on those days. Mary needs to give herself credit for her progress made
- 7. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 7 rather than feel helpless, but understandably that’s a difficult thing to do when you feel physically handicapped. Environmental Obstacles Mary’s environmental obstacles are people and agencies that do not work from a Strengths Based Model or praise her for positive behaviours. Motivation helps Mary a long way, but there are still many people that focus too much on the problem and not about the progress. Her separated husband does not see or appreciate the steps she has taken. Woman Kind is structured as an incarceration rehabilitation centre, where women are not allowed to leave until specified hours, are only allowed to participate in programs when they display good behaviour and are bound to a curfew. Her experience with that agency has shown her she struggles with traditional social work models. Fortunately, Mary is starting to understand where the positive agencies, people and resources that will work for her are located. Strengths Based Plan for Mary Mary has already started to take her first steps in a Strengths Based Plan that she has almost created herself. She has built on her self-awareness greatly since her last attempt at reaching sobriety. It is my job to help guide Mary and keep her on the track she is currently on. Step 1. Praise for Self-awareness Continue to reinforce and encourage her independency and her ability to analyze her self Maintain contact with Mary and discuss progress regularly Allow Mary to understand that she is the expert, cater to her needs as she presents them Step 2. Guidance
- 8. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 8 Provide Mary with resources that are specifically researched for her Consistently reinforce the values of Alcoholic’s Anonymous even though she expresses dislike for that program Help Mary keep an open mind to new ideas and solutions Step 3. Managing Obstacles Personal Obstacles Really focus on her progress on days where her depression and health issues arise Create incentives and rewards for Mary to indulge in during difficult times Help Mary understand that failure is not the end, it means there is a fresh start at solving problems. A chance to look at things differently. Provide support and resources that can help Mary effectively deal with mental health issues if it becomes more of a prevalent day-to-day problem Environmental Obstacles Redirect Mary from traditional social work agencies and negative influences Continue to increase her relationship with her mother Keeping Mary active in volunteering and creating new relationships Have Mary advocate for others that may not understand the perspective of a Strengths Based Model In summary, Mary should continue on the path she has chosen. I am here to provide resources as she needs them and intervene every so often just to check in and keep progress
- 9. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 9 moving. Mary is aware of the resources she has and just needs to continue to utilize them. It is important that Mary stays resilient to the negative people and agencies in the community as it is much easier to tear someone down for their weaknesses than build someone up for their strengths. In general, the Strengths Based Model is perfect for Mary. Her depression can cause some lacking self-esteem issues, but support and praise for her good work helps negate those effects almost entirely. The only negative I foresee using the Strengths Based Model is that Mary describes herself as very resistant and stubborn if she falls into a strong drinking period. She has a tendency to lie, become very introverted and avoid reaching out to anyone. She puts heavy blame and stress on herself and has stated that it takes firm work and highlighting just how bad things are in that moment. Unfortunately, the Strengths Based Model is meant to be a passive solution to problem behaviour by distracting clients from the negatives and encouraging the positive behaviours. The Strengths Based Model also does not put anyone ahead of Mary as the boss and the expert, so according to her self-diagnosis, a firm aggressive stance is needed and the Strengths Based Model does not provide a strong firm stance when it comes to those negative behaviours. Person-Centred Therapy Theory The theory that would most effectively apply to Mary is the Person-Centered Therapy theory. This theory invented in the 1940’s heavily influenced by Carl Rogers, states that every human has a natural potential and follows the concepts of Maslow’s Hierarchy of Needs with self actualization as the ultimate goal. This theory assumes that people are good by nature, that everyone has the ability to work as an individual as well as utilize resources and be a resource
- 10. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 10 themselves. This theory understands that there cannot be someone that understands the client more than the client (Singh, 2016). The Person-Centered Therapy theory aims to increase self- esteem by putting the person in the forefront rather than the problem. Workers participate in all acts of life in this theory, rather than just being available for when trouble arises. This creates a very intimate, personal relationship between client and worker. Mary has shown a genuine interest in change and when she receives caring behaviour that guides her in the right direction, her response and progress is duly noted. Mary has great self-awareness skills and her concept of reality and society are proper and her understanding of her surroundings are sound. This theory also applies well to Mary because of her expressed dislike of AA and Woman Kind. It is clear that heavily structured programs are not as effective for her. This theory states that therapists or workers do not need to posses any specific skills or knowledge and that a genuine and empowering relationship is what works best. Again, the negatives of the Person-Centered theory are that it does not support firm and aggressive behaviour during times of crisis. This theory works diligently, calmly and passively much like the Strengths Based Model does which has proven to work miracles for Mary, but in a time of immense need, some of the calm empowering will not work effectively. Rather, Mary needs to be given an understanding of what she is doing wrong. Of course this must be done with respectful language and it is not to be done in a way that tears at Mary’s insecurities and attacks her failures, but she needs to have a stern worker that is not afraid to admit Mary’s problems for her when she finds herself unable to control.
- 11. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 11 References Hammond, W., & Zimmerman, R., (2014) A Strengths-Based Perspective, Resiliency Initiatives, https://www.esd.ca/Programs/Resiliency/Documents/RSL_STRENGTH_BASED_PERS PECTIVE.pdf Hough, M., (2012). Counselling Skills & Theory. Hodder Education. Norfolk County United Kingdom (Pg 124 -140) Mehr. J., & Kanwischer R., (2004). Human Services: Concepts & Intervention Strategies. Pearson Publishing Toronto Canada (pg 123-137) Singh, L., (2016). Person-Centered Therapy Lecture, Mohawk College https://elearn.mohawkcollege.ca/d2l/le/content/334275/viewContent/2635665/View?ou= 334275 The Stages of Change (2009), Transformation Children’s Services System http://www.cpe.vt.edu/gttc/presentations/8eStagesofChange.pdf Volz, C., (2009). Family Engagement Strategies, Transformation Children’s Services System http://www.cpe.vt.edu/gttc/presentations/8VAModelsFamilyEngage.pdf
- 12. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 12 Appendix Interview with Mary Question 1: Where do you believe this alcoholism stems from? Answer 1: There are different things that contribute. PTSD and depression from my childhood is a big factor. Financial stress, I want to move my son and I away from here. The landlord is a dick, the place is falling apart, we cannot treat this place like home because of the history along with it. Question 2: Elaborate on the history of your current home, why is it difficult to be there? Answer 2: As I mentioned, the landlord is awful. He does not care for us. My son has had a hole in his ceiling for 3 years and the landlord has not tried to once fix it. A majority of my alcohol problem has been in this house as well. My room wreaks of booze. I’ve spent so many hours hiding in my room with a bottle of wine hoping that if I just drink, it’ll help me sleep. My son has tried hard to deal with things as nicely and calmly as he can, but he’s 21. He has a life, and sometimes he gets really frustrated with me but I can’t blame him for that. I’m ashamed that I have become and alcoholic, but I’ve also developed a problem with lying to try and hide the fact that I drink. Moving out of this house would help get the both of us in a new environment. Question 3: It definitely seems like you’re aware of the problem and that’s good. You also have some understanding of what you think would help, which is great. It shows that it’s an active
- 13. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 13 thought in your head to try and conquer this addiction. What are some of the things you’ve done in the past to try and work on this? Answer 3: I’ve gone to many AA meetings. I’ve checked into Woman Kind which is a woman’s shelter for addictions. I’ve undergone a 1 month of living in that shelter. It provided some benefits but I want to rehabilitate on my own terms, I don’t want to be locked up in a shelter or have to follow such a structured program, but my progress has waivered. I am ready to start from anew, from step 1. My brother died from a drug overdose and it haunts me that I could be following his path. He died young and I wish for him back everyday, I don’t want to put my family through that. Question 4: I’m sorry to hear that, but your plan and past progress sounds great Mary. Tell me about some of the relationships that you have. Are you married? Answer 4: I am separated from my husband. I have been for about 7 years now. Our relationship was toxic, there was very little love and support for one another. Not to put the blame on anyone, but he also had an addiction problem with drugs, so it created a great atmosphere for my addiction to thrive in as well. My relationship with my son is broken but we are trying to repair it. He lives at home with me and has been through every step of pain and frustration as I have been. I’ve done a lot of lying to him but he still tries to support me. I have a good relationship with my mother and my sister. They have also endured a lot, but they still remain supportive. In general, my relationships are healthy. I took the time to get rid of toxic relationships with old friends and the relationship with my husband remains at phone calls or short in person interactions.
- 14. METHODS OF INTERVENTION: STAGES OF CHANGE ASSIGNMENT 14 Final Comment: That’s a great move on your part to be able to recognize these things. That’s not always easy to break off a relationship like the one with your husband but you made a decision that has proven to create a healthier environment for you and your son.