Mary Richmond introduced the conundrum that _______
A. social workers are only respected if they can make a difference
B. social workers require plenty of experience to be social workers
C. social betterment and individual betterment require each other
D. people often have insufficient desire to change their circumstances
C
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Which is a true statement about how a worker can be affected by the suicide of a client? a. The situation evokes guilt in the worker
b. The worker can be shunned by other workers in a form of flight from pain. c. The supervisors' non-response to the situation can make the worker feel abandoned. d. All of these answers.
Is there evidence of symptoms of mania or hypomania currently or in the past?
DSM Diagnosis 296.32 Major Depressive Disorder, Recurrent, Moderate with Interepisode Recovery V15.81 Noncompliance with treatment V60.89 Discord with Neighbor, Lodger, or Landlord 340 Multiple Sclerosis Rationale The client meets criteria for Major Depressive Episode due to the presence of the following symptoms for several weeks nearly every day: depressed mood; diminished interest or pleasure in activities; increased sleep; psychomotor retardation; fatigue and energy loss; and thoughts of self-harm. There have been at least two previous episodes reported, both of which required psychiatric admission. The current episode is moderate and not severe enough at this time to require inpatient psychiatric admission. The longitudinal course specifier “with interepisode recovery” was assumed as Tammy stopped taking her antidepressants because she “felt better.” Tammy has also been given two V codes. The first is Noncompliance with Treatment as Tammy has been hospitalized for her depression, given a prescription for an antidepressant medication, and recommended that she sees a psychotherapist. Once she begins feeling better, however, she cancels therapy appointments and stops taking the medication. The V-code Discord with Neighbor, Lodger, or Landlord was also assigned to capture the problems in Tammy’s living arrangement with her roommates. Additional Information Required Questions can be asked of Tammy to determine if she has had manic or hypomanic episodes in the past. Inquiry surrounding Tammy’s past history of depression before she was living in her current circumstances would be necessary to understand whether her depressive symptoms are an ongoing reaction to a stressful housing situation or a more entrenched pattern. We could also confirm if the “with interepisode recover” longitudinal specifier is correct by asking about symptoms in between depressive episodes. Although there is no evidence of clinical impairment from her cannabis use, further questions could investigate this possibility. In addition, to determine whether a cannabis dependence diagnosis is warranted she could be asked about tolerance (does she notice that it takes more marijuana to “get high” as compared to the past?) and withdrawal (during periods of non-use has she noticed symptoms of withdrawal?). Risk and Resilience Assessment Onset Tammy’s risk mechanisms for the occurrence of depression at the biological level include her female gender and the fact that she has a serious and chronic health problem. Fortunately, she accesses services for her disability at the rehabilitation hospital and has formulated attainable goals. At the psychological level, some of her lifelong coping strategies seem to be avoidant. For example, she smokes marijuana to help her feel better. It could also be inferred that she took a passive role in managing her finances, which resulted in eviction from her apartment, debt, and being removed from eligibility for public housing. On the protective side, she is thankful for what she has, shows a strong faith, and believes she can get through her difficult circumstances. At the social level, Tammy also has a number of risk mechanisms. She has poor intimate relationships (she is divorced and estranged from her family) and has low informal social support outside of her family. Considering more formal support systems, she does access the services of the rehabilitation hospital to meet her health needs. Course Tammy must continue to live with MS and due to the debilitating nature of that disease will be at risk for additional depressive episodes. The fact that she has experienced multiple depressive episodes of a serious nature indicates a risk for ongoing difficulty. If her cognitive style continues to feature passive rather than active coping styles she will be at risk for a longer course of depression. The fact that she seems eager to address some of her family and interpersonal problems shows hope that she will make adjustments from her current style and perhaps acquire skills and cognitive patterns that will protect her from future episodes. Her ongoing use of formal support systems indicates that she may function better in the future as well. What techniques can be used to elicit further strengths? 1. Ask about the resilient qualities Tammy has shown to make it this far despite the pain she has endured in the past. 2. Ask coping questions, such as “Your situation sounds very difficult.” “How have you been able to manage with all the things you’ve been going through?” 3. Ask about previous accomplishments, such as how she was able to quit smoking crack. What strengths, qualities, and supports did she draw upon to do this? 4. Exception finding questions: Inquire about times in her life when she was feeling better. What was she doing differently then? 5. Externalizing: When does she feel like she can control the depression, drugs, and MS symptoms? When is she able to stand up for herself and not allow her roommate’s sons to “get on her?” When is she able to decline offers of marijuana? 6. What will the future look like when Tammy’s current problems are solved? What will she be doing, saying, and thinking when you no longer have these problems? 7. Decisional Balance: What does Tammy get out of using marijuana (e.g., help her cope with depression) and what are the negative consequences (e.g., may contribute to apathy and fatigue, may lead to other health problems, makes antidepressants less effective, money spent on marijuana could be used to get herself in a healthier living situation)? Treatment It is critical to address Tammy’s depression not only because of her pain and suffering, but also because depression can exacerbate cognitive dysfunction in people with multiple sclerosis (Arnett, 2005). The first priority is to find a better housing situation for Tammy, and she also needs assistance with other concrete services, such as transportation. Further, her social support system needs bolstering. These arenas are important for the social worker to address in addition to psychotherapy for depression. The social worker linked Tammy to a local non-profit agency that owns and operate multiple affordable housing units for people with mental illness, and Tammy was placed on the waiting list for housing. Tammy was also referred to legal services for assistance with her debt with public housing. The social worker further offered to meet with Tammy’s roommates and Tammy to try to work out a better living situation for Tammy. The social worker informed Tammy that some churches offered transportation for people with disabilities, so Tammy was going to call her church and find out whether this was a possibility. She also agreed to inquire about whether the church could help with housing options. The social worker further arranged for Tammy to receive a pass for public transportation for those with disabilities. In this way, Tammy might also be able to attend church services and other events. Tammy was referred to the local chapter of the Multiple Sclerosis Society. She called the Society and found a local support group to start attending. Perhaps in this context, she might find other housing options, as well as support and information about her disease and how to manage it. The social worker can also provide cognitive-behavioral therapy for Tammy’s depression. Cognitive-behavioral therapy has been validated not only for depression for people with multiple sclerosis but also to help people cope with the diagnosis of multiple sclerosis. Another advantage with cognitive-behavioral treatment is that it can be used to address Tammy’s problematic substance use, although it must be recognized that marijuana is sometimes used for the pain associated with MS (Smith, 2005). The social worker will focus on helping Tammy develop active coping mechanisms, such as problem-solving and communication skills so that she can better relate to her family and with other people in her life. One service delivery option, given Tammy’s problems with mobility and transportation, is to offer cognitive-behavioral therapy administered through the telephone. This method has shown effective with people with multiple sclerosis (Mohr, Hart, Julian et al., 2005). Finally, due to her history of flare-ups of multiple sclerosis when under stress, the social worker further thought it advisable for Tammy to schedule an appointment with the psychiatrist to discuss the possibility of taking an antidepressant again. Critical Perspective There is high co-morbidity between multiple sclerosis and depression, which may not be limited to the psychosocial aspects of having a disease but also might stem from biological processes. Imaging studies have indicated depression in MS might be associated with “neuropathology in the left anterior temporal/parietal region of the brain” (Siegert & Abernethy, 2006, p. 471). If we were to consider Tammy’s depression as arising from the biological aspects of MS, the diagnosis would have been Major Depressive Disorder Due to a General Medical Condition; however, there is no standard testing that is done to establish the biological basis of depression with MS. In addition, Tammy had a number of stressors, to include not only her disability, but also her financial, housing, family, and social situation. The depression could have arisen from a multiplicity of factors, involving biological and psychosocial factors. This case also shows how external stressors may play into a disorder such as Major Depression, indicating once again the importance of the person-environment context rather than just individual dysfunction in the development of disorders.
The text described _____ as a national self-help organization for heart surgery patients and their families.
A. Hearts Entwined B. Heart of My Heart C. Mended Hearts D. Broken Hearts
From a systems perspective a value-free science is not possible because:
a. Subjectivity is inevitable b. Subject/object dualism is inevitable c. The focus is individualistic d. The focus is historical