Introduction This essay is based around a children and families case study and will first set out the significant issues for the individuals involved before outlining the policy and legislative….
Social Work Psychosocial Assessment
APRIL’S PSYCHOSOCIAL ASSESSMENT Referral April was not a referral client; rather she did her own research after feeling unsupported by her previous therapist. She found this practice on the Pratt Institute listserv as she was looking for a psychologist close to school. According to April, she received a diagnosis of stage three Non-Hodgkin Lymphoma five weeks ago and had not told anyone close to her. She wanted to talk to someone “objective” to figure out what steps to take next. Client Identification
Demographics: April is a 23 year-old woman who currently lives on campus at Pratt Institute studying architecture and urban planning. Her parents are married and she has a 21 year-old brother, Daniel, who has a diagnosis of Down syndrome. Her father used to be in the army and now works for the US Department of Veterans Affairs, her mother cares for her brother. Employment/Education: April is in her second year at Pratt and presents to overwhelmed with current workload, yet managing to get by.
She seems focused and undeterred by her presenting issue to complete her education. It is unclear if April is employed, she did not mention it. Income and Source: As stated above, it is unclear if April is currently working, receiving financial help from her parents, or receiving government loans and bursaries. Further information on her sources of income may need to be clarified to determine as this could have an impact on the care available to her in the near future. However, her interest in alternative medicine could mean she is not worried about finances.
Living Environment: The specifics of April’s living environment are unknown. She has not stated any concerns about her living situation. Sources of Information The information contained in this assessment was acquired in an in person appointment with April that she scheduled. No information was obtained from any other sources. Problem Definition April was diagnosed five weeks ago with stage three Non-Hodgkin Lymphoma. April stated she feels “tired” and has been experiencing “night sweats” lately.
Although, she states that she “knows” she has cancer, she seems to be in denial about the severity of her illness. April has a hard time talking about her diagnosis (she had to write it down), and seemed to be avoiding what she came to talk about although she expressed wanting to talk with someone objective who was not personally invested in her well-being. April was previously seen by a Pratt therapist, which she stated did not go well though she found her old psychiatrist “nice enough”, she felt that she was only a good listener with “nothing to say”.
She seemed to be annoyed with the previous therapists attempts to contact her after she decided to stop going, although she did not let her know she would not be returning. April became very defensive when talking about her family, when this worker asked if she felt that her brother took up most of her mother’s time, she quickly shot the idea down. She presents as being exceedingly independent, yet extremely loyal to her family. April communicated that she is falling behind on her schoolwork, she seems particularly concerned with maintaining her current life and does not appear to be taking her diagnosis seriously.
April expressed wanting to explore her other options of acupuncture, herbal therapies, and meditation even though her oncologist suggested she begin chemotherapy immediately. April appears to be experiencing an internal conflict and seems to have a hard time trusting others or asking for help. History/Antecedents: April stated that she had a cough that would not let up, as she grew tired of coughing in class she finally went to the health counter at Pratt. She was prescribed antibiotics, which did not help her cough.
She had resigned herself to wait to speak to her dad, a retired army official now working for the US Department of Veterans Affairs. When she began experiencing night sweat she returned to the health center, where she was annoyed to be accused of taking diet pills or using cocaine. After being sent to the Brooklyn hospital for a chest x-ray, a big mass was discovered behind her spine. A bone marrow biopsy was done and she was diagnosed with stage three non-Hodgkin lymphoma. It has been five weeks since April’s diagnosis and she has not told her parents or anyone close to her.
It is unclear if April is aware of the magnitude of her illness, though she stated she knows she has cancer, she does not appear to be taking the diagnosis seriously rather she is carrying on with her life as if nothing has changed. April expressed that perhaps she does not want treatment and maybe she would rather die than put her life in someone else’s hands. It is unclear if April truly believes that she has cancer. Past Solutions: As indicated previously, April received her diagnosis five weeks ago and presents as being in denial as to the seriousness it entails.
She previously was seeing another therapist, however she did not like her and stopped going after only two sessions. It is not clear as to what was discussed in these sessions, as April only said that her previous therapist was not much older that her, had “nothing to say”, and told her “the same story twice”. She stated that she stopped going without telling her therapist she would not be returning and was overtly annoyed when the therapist tried to reach her many times after, which she felt was “over the top”.
April stated she has not yet began seeking medical treatment, nor has she confided in her family as to her situation for their support. April seems overly concerned with the reaction her family will have upon receiving the news of her illness. It is likely that she is keeping this information from her family to protect them as well as to maintain her independence. Contributing Factors: April’s diagnosis of non-Hodgkin lymphoma was not brought on by any factors determined in the session. However, April’s tiredness and night sweats are probable symptoms of her illness.
It is likely that April’s independence is making it hard for her to tell her family and friends about her illness. She also stated that her brother’s autism took up a lot of her mother’s time and that “no one talks about her” this could show where her independence developed from. April spoke about her recent break up with her boyfriend who she remains good friends with but has a new girlfriend from a well off family. April stated that she has not told her boyfriend or friends about her diagnosis; April may be believing her denial of her diagnosis and keeping it to herself, makes it less real.
Her inability to talk about her diagnosis may be a factor of her need to control her life as an independent young woman and not wanting to ask for support with her illness should be further explored. The Client System Functioning: April became defensive several times during this interview. She stated that she did not want to talk about her cancer diagnosis many times during the session. She expressed that she has been feeling tired and having trouble sleeping, experiencing night sweats and waking up in a soaked bed. Other than the above April appears to be still functioning at a high level nd is able to get to school and besides her recent assignments is doing fine at school. It should be noted that April appears physically to be in good health, she is a well-dressed, attractive young woman. She appears to be well spoken and intelligent, yet she is in denial about her illness. Strengths/Coping Skills: During this interview April was commended for her independence, also her loyalty towards her family was also a strength brought to her attention. April seems to have a strong support system, although she is not using it at the moment. She has family and friends who care about her.
April’s ability to remain in school and continue on with her studies is also a strength to be noted. Her communication skills are well developed, even though she was unable to express herself in this meeting there is potential for it in the future. Relationships and Social Support: It is unclear what the extent of April’s relationship with her family, friends, or community is. As stated earlier, April is a very independent young woman and though she did mention her family in the interview, she has not told them about her illness as she does not want to put any stress on them.
Further exploration regarding the depth and quality of her relationship is needed. During the interview, April expressed that she and her ex-boyfriend are still “good friends” and that they get along great. He however is unaware of her diagnosis. April mentioned she has other friends but no other details were provided. April seemed to take a liking to this worker, and expressed being happy that this worker was older than she had expected. She seemed to have an easy time talking as long as she was guiding the conversation but closed up upon being asked questions she did not feel like answering.
Resources/Obstacles: April acknowledged that she does not like to ask for help, she stated that she was able to go see a therapist at school. Though the sessions were quickly terminated they lead to her finding this practice and setting up an appointment. Although, she finds them inefficient, April identified the school’s health center and her oncologist as a present resource available to her. April mentioned her family but it is unclear if she sees them as a resource. She stated her brother suffers from autism and takes a lot of her mother’s time, and father is often busy.
April also mentioned she has a good relationship with ex-boyfriend but acknowledged that she does not confide in him or her other friends. This suggests that April is used to fending for herself and her independence is an important resource to her. April’s need to control a situation presents as a obstacle for her, as she seems to close people off when they get too close to asking information she is not ready to share. This may have been the case with her previous therapist who she stopped seeing, claiming she was “incompetent”. April did not mention any other support systems.
It is unclear if she has other individuals she can rely on and appears to have issues with relatedness. Professional Opinion April appears to be in denial about her diagnosis of stage three non-Hodgkin lymphoma and what it entails. April appears to be taking the diagnosis as a big inconvenience rather than recognizing the seriousness if holds. April has not began treatment, although her oncologist has recommended that she begin immediately. She appears to be an intelligent, independent, young woman; it is possible her apprehensions on sharing her diagnosis with family are related to her not wanting to lose her independence.
April appears to be more concerned with what her family’s reactions to diagnosis will be and the stress it may cause them, rather than what the diagnosis means for her health. It is this workers opinion that April is used to taking care of herself and is fearful that her parents will not be there to support to her if she puts herself out there. April’s having chosen to look into alternative medical treatment, even with her oncologist’s advice to begin immediate treatment, shows her need to be in control of her life.
It is this worker’s opinion that April is fearful of giving up the one thing she has depended on her entire life; her independence and ability to care for her. During the interview, April mentioned other relationships; her ex-boyfriend, his new girlfriend, and friends. While these people maybe able to provide support to her in the future, April is currently not ready to share her diagnosis or ask them for help. Plan An intervention plan was not created as April left without formulating a plan or scheduling a second session.
However, it is this worker’s opinion that the following steps need to be taken; April needs to recognize that there is no shame in asking for help or relying on others in her time of need, April should talk to her oncologist about her considering alternative medicine and see how she thinks she should proceed, and April needs to tell her parents about her diagnosis. As she left without scheduling an appointment and this worker is unaware if she will call to schedule one, it is unclear of what will transpire. However, this plan will be further discussed with April if she does make a second appointment.