Social work as a complicated and multi-faceted sphere of professional activity involves a diverse number of significant issues that need to be addressed when carrying out counseling procedures for clients. The task of a social worker’s performance is to ensure human rights observance for all clients regardless of their cultural, economic or educational background. A competent social worker always prioritizes client’s rights for freedom, education, health care, and safety (Poulin, Matis, & Witt, 2018).
Thus, it is essential to act with empathy and lack of personal interest with the aim to help people resolve their social issue and acquire the opportunities to improve their lives. This presentation of an assessment will address the case of Claireece Precious Jones, the main character of Daniels’ (2009) film under the title Precious.
The client is an illiterate sixteen-year-old HIV-positive African American teenager who suffers from obesity and is continuously exposed to rapes by her father and physical and emotional abuse from her mother. Claireece Jones was twice impregnated by her father and is currently pregnant with her second child. Her first child has down syndrome and lives with the client’s grandmother. All the mentioned conditions of Precious’ life are regarded as constant stressors leading to severe issues in mental health.
In this case, the social worker carrying out her assessment and treatment plan should take into consideration the oppression and abuse that the client was exposed to since being a toddler. The client shows the symptoms of an eating disorder and dissociative identity disorder as the results of repeated acts of abuse that Precious has been exposed to throughout her life. To resolve the identified problems of the client, the social worker needs to establish consent, discuss confidentiality terms, carry out assessment procedure, and thoroughly address the steps of interventions implementation within the treatment plan.
Consent and Confidentiality Issues Discussion
When working with clients, social workers act according to the law and carry out the procedures that are recognized to be legal. For the assessment and treatment plan to be implemented in practice, it is necessary to establish a client’s consent and articulate confidentiality terms.
This initial stage of work with an individual is essential, and its success contributes to the overall advancement of the treatment. The ethical principles that prioritize respect for the personal dignity of a client, his or her free choice, and the right to improve living conditions must be preserved by a counselor (Poulin et al., 2018). Regarding the social context and the particularities of a case, the procedure of consent establishment might differ.
However, the core of informed consent establishment lies in some main points that need to be addressed at all times. According to Morley, Ablett, and Macfarlane (2019), there are six primary issues regarded as standards for informed consent. The client should give his or her permission voluntarily (if not decided in court) without outside influence or coercion. The client’s mental health condition has to be sufficient to provide consent. Also, the person exposed to social work needs to be aware of the exact interventions that are planned for the treatment. Moreover, these interventions, as well as consent forms, “must be valid” (Morley et al., 2019, p. 49).
It is important to preserve the client’s right to withdraw consent if needed. Finally, the decision to participate in the interventions must be “based on adequate information” (Morley et al., 2019, p. 49). Thus, the social worker preparing the informed consent for Precious as a client needs to thoroughly address the discussed issues to ensure the legality of the procedures.
The procedure of consent and confidentiality discussion will be held at a governmental social services agency setting. Taking into consideration the particular case of Precious, it is valid to obtain informed consent from the client despite her age. She has been exposed to constant abuse from her parents who caused her mental health complications. Thus, the social worker’s aim is to protect the client from harmful influences and ensure safety and freedom to access counseling services (Clemens, 2014).
Initially, an interview with the client has to be conducted for the purpose of informing about the need for consent provision. During the meeting, the counselor should present all valid data necessary for the client to have before signing the document.
To ensure the legality of the procedures, the social worker should introduce the client with information about the ways protected health information retrieved during the assessment would be used for the treatment purposes. Precious will be informed about the goals of counseling addressing the anticipated changes she will come through to eliminate the identified problems. It is important to let the client know about her ability to influence the direction of the interventions based on her own will (Poulin et al., 2018).
The social worker will provide competent information about possible risks the proposed treatment might impose, as well as the benefits and positive outcomes it might present. It is necessary to include an introductory observation of the character of interventions, their frequency, duration, and the form of meetings.
In terms of confidentiality discussion, the client needs to be ensured that her private health information will not be disclosed to any third parties except for the identified ones. These third parties could be the professionals in the same field or colleagues who might be consulted during the treatment sessions. Any other disclosure of information will not be possible unless the client expresses the wish to do so.
The client’s right to confidentiality should be preserved throughout the interventions implementation (Poulin et al., 2018). The records being kept by the counselor during the treatment process will also be regarded within the confidentiality terms and will not be disclosed. However, it is also important to inform the client about the limitations to the confidentiality of personal information in case if she visits group meetings where privacy is difficult to maintain.
The Choice of Theories and Interventions
The client is identified several problems, including dissociative identity disorder (DID), eating disorder, and illiteracy. These issues should be addressed in the treatment plan and obtain accurate addressing from the side of a counselor who establishes the perspectives for future work of the therapists. It is essential to establish the client’s access to the educational facilities to eliminate illiteracy and obtain a sufficient level of knowledge for adequate development in the future. The educational interventions will contribute to the goal setting and will facilitate the recovery process.
Dissociative identity disorder is the result of Precious’ constant traumatization both, physically and emotionally, since her early childhood. Her desire to escape from the oppressing reality produced the appearance of alternative identities. Precious is daydreaming and constantly imagines herself to be in a different environment that ultimately differs from the surrounding in which she lives (Daniels, 2009). It is valid to address DID through psychodynamic theory to apply necessary interventions.
To succeed in DID treatment, one may apply the method of eliciting “personally important memories” within “the self-defining memory paradigm” (Huntjens et al., 2016, p. 217). Using therapeutic interventions aimed at the retrieval of the autobiographical memories would contribute to the personal self-identification and the integration of alternative identities into one healthy personality. The DID therapist involved in the treatment process should consider long-term cooperation with the client due to the severity of the case and the duration of her exposure to abuse.
An eating disorder resulting in obesity leads to the client’s body image dissatisfaction. Precious refuses to perceive herself as an obese African American teenager, which is why she sees a skinny white blonde girl in the mirror every time she looks at herself. It is unnecessary to apply a systems theory which underlines the role of a family in the recovery process. In Precious’ case, her family is the greatest hazard that is the core of the problem.
Sexual, emotional, and physical types of abuse were initiated by her father and then by her mother, who continuously suppressed her since the girl’s early childhood (Daniels, 2009). It is vital to ensure the family’s awareness about the mental health condition and risks related to it to guarantee support for speedy recovery. Thus, the treatment of an eating disorder should be maintained within the framework of the cognitive-behavioral theory that resolves the issues with the help of psychotherapeutic interventions aimed at the minimization of symptoms.
Among the interventions capable of contributing to the recovery process, there should be those establishing control over binge eating. To cure addictive behavior, a therapist might consider suggesting the client attend group meetings of addicted patients.
The social support experienced during the sessions will contribute to the overcoming of anxiety (Agras, Fitzsimmons-Craft, & Wilfley, 2017). Educating dietary and implementing mechanisms and exercises to eliminate the connections between eating disorder symptoms and the memories of sexual abuse will facilitate the recovery process. The choice of the theories and the interventions for problems solving is dictated by the considerations of the complexity of the cultural background of the client. Her case is characterized by the severity of multi-dimensional mental health issues and the diversity of roles the client needs to perform in her life, including the functions of daughter, mother, and a student.
Major Developmental Stages and Developmental Theories of the Client’s Age Group
The fact of the client’s belonging to a particular age group influences the overall treatment planning and the specifications of the implemented procedures. Precious is a sixteen years old teenager who is exposed to the natural changes in her body and mind. Form the point of view of its definition, adolescence is a specific phase of human life “stretching between childhood and adulthood” which is characterized by biological growth and “social role transition” (Sawyer, Azzopardi, Wickremarathne, & Patton, 2018, p. 223).
There are different developmental theories applied to adolescent age group; they might be divided into biosocial, organismic, and contextual perspectives (Curtis, 2015). The first group of methods addresses an individual’s development from a biological perspective.
The second group includes such theories as psychosexual, psychosocial, cognitive, and moral. The third group consists of anthropological, behavioral, and developmental approaches which view an individual as a part of a contextual dimension (Curtis, 2015). It is valid to address the case of Precious from the perspective of the behavioral theory due to its wide scope of opportunities to recover on the basis of the acquisition of new behavior.
The major developmental stages of adolescents include early adolescence reached by individuals between 11 and 13 years old, adolescence represented by teenagers of 14-17 years old, and young adulthood characterized by the age of 18-25 (Curtis, 2015). Precious is currently at the second stage of adolescent development and is exposed to the challenges of adult body acceptance, advancement of cognitive operations, and the overall perception of oneself as an adult human being. Due to the long-term treatment plan applied to the case of the client, it is the social worker’s and therapist’s duty to address the transition particularities of the patient when she reaches the final stage of development of her age group.
Self-Critique of the Project
The case presentation of the assessment was a challenging and complex experience from both scholarly and emotional perspectives. The analysis of the mental health issues of the client included a thorough addressing of the causes of DID and eating disorder. The abuse and parental neglect that Precious endured during her childhood are severe and difficult to comprehend. Empathy as one of the basic skills of a social worker becomes a restraint when addressing all the problems the girl has to overcome to be a decent and full-fledged participant of the society.
This project was also demanding in terms of the literature analysis and its application to the particular issues within the case. The work of the assessment provided useful lessons concerning the applicability of therapy theories regarding the social and mental problems of a client, as well as the carrying out necessary procedures such as consent establishment, client assessment, and treatment plan development.
Among the major strengths of the project are the accessibility and the objective nature of the data about the client and her environment, as well as the causes of her mental disorders. A great scope of literature that facilitated the scientific basis of the assessment is also a significant strength. Accurate addressing of the separate problems Precious experiences contributes to the validity of the treatment plan and is an advantage in her recovery process. The weaknesses of the assessment are related to the overall complexity of the case.
The client suffers from multiple problems including obesity and eating disorder, dissociative identity disorder, illiteracy, and anxiety. It is difficult to include all the issues into an effective treatment plan and ensure its accurate processing. The interventions suggested for treatment are planned within a long-term perspective, which is also one of the weaknesses due to the vagueness of the anticipated results. However, the analysis of the available resources provides positive insight into the procedures and mechanisms that will contribute to the client’s recovery.
Conclusion
To sum up, the case of Precious as a complex combination of diverse mental health disorders emerging due to constant endurance of sexual, emotional, and physical abuse is a challenging task for a social worker. The client suffers from dissociative identity disorder and eating disorder as the protective mechanisms in the oppressive real-life situations. Moreover, she is an adolescent reaching a transitioning stage of development that complicates the recovery process.
These issues can be addressed if the case is competently assessed and a treatment plan is developed. The interventions aimed at DID treatment should be carried out within the psychodynamic theory, and the procedures targeting eating disorder elimination should be conducted through the cognitive-behavioral theory. In case of thorough inclusion of the therapists, social worker, and the client into the process outlined in the plan, positive long term goals will be achieved.
References
Agras, W. S., Fitzsimmons-Craft, E. E., & Wilfley, D. E. (2017). Evolution of cognitive-behavioral therapy for eating disorders. Behaviour Research and Therapy, 88, 26-36.
Clemens, J. W. (2014). Client system assessment tools for social work practice. North American Association of Christians in Social Work. Web.
Curtis, A. C. (2015). Defining adolescence. Journal of Adolescent and Family Health, 7(2), 1-39.
Daniels, L. (Director). (2009). Precious. USA: Lionsgate Studios.
Huntjens, R. J. C., Wessel, I., Ostafin, B. O., Boelen, P. A., Behrens, F., & Van Minnen, A. (2016). Trauma-related self-defining memories and future goals in dissociative identity disorder. Behaviour Research and Therapy 87, 216-224.
Morley, C., Ablett, P., & Macfarlane, S. (2019). Engaging with social work (2nd ed.). New York, NY: Cambridge University Press.
Poulin, P., Matis, S., & Witt, H. (2018). The social work field placement: A competency-based approach. New York, NY: Springer.
Sawyer, S. M., Azzopardi, P. S., Wickremarathne, D., & Patton, G. C. (2018). The age of adolescence. Lancet Child & Adolescent Health, 2, 223-228.