The client name is Mr. X, a 48 years old male, American who lives with his daughter and nephew. They come to visit every day of the week plus weekends. Client suffers from kidney failure as he has stage four kidney cancer and refuses to continue dialysis. He is bipolar and suffers from sundown syndrome and is always moving, babbling, irritated and confused. Client takes 10mg lithium carbonate and undergoes psychotherapy. He is now in the recovery ward. (Garthwait, 2014).
As a social worker, who interacts with various clients both in a home setting and in assisted living, I met with the client during the internship on 2/14/2017 at the Good Shepherd Hospice, where he was receiving palliative care. Our meeting with the client gave him the preliminary assessment of the situation and provided advanced care planning which entails communicating information about kidney cancer diagnosis, treatment options for bipolar disorder, life goals, values, and wishes. Further, provided the client with hope, towards a new life. (Cheryl, 2009).
Given that Mr. X had refused to continue with dialysis, and suffered from recurrent irritation and moved up and down, against the doctors advice, I gave him a short-term psychological counseling to address the issues and talked with clients loved ones to fully support him in the process. To ensure overall recovery, some of his family members who included his eldest daughter and nephew came in for a one- on -one session as we briefed them on his situation.
I had prepared open-ended questions before our meeting. On a review of Mr. X's file, I discovered that he had not used Topamax or topiramate, one of the best bipolar disorder drugs available on the market. It acts as a mood stabilizer for those afflicted with manic depression suffered by the client. I desired to know why the client refused to continue with dialysis, as such, I redirected my questions to Stephanie who briefed me on the clients health history as Mr. X was adamant. All the information was put down in my social work internship diary, and at the same time, I took to fill the process recording template. With previous research I had conducted on life expectancy on dialysis, I informed Stephanie that Mr. X could survive for up to 5 to 10 years while living on dialysis as it keeps the body in balance by removing extra water, waste and salt, and prevents them from building up in the body. Again, with his bipolar and sundown syndrome condition, following his treatment plan guaranteed survival.
As I sat beside him, smiling, I gave acceptance to Mr. X when I asked him to tell me what his thoughts were. He mentioned that he feared that the disease was out of his control. I touched his shoulder as a sign of being emphatic. I told him that as a social worker and part of the Good Shepherd Hospice team, I was skilled in assisting people to control and deal with many difficulties that result from illness (CUSSW, 2015).
I told him that I wanted to find out how his weekend was and if he was anxious about continuing with dialysis from coming week. Mr. X breathed in and out as if to prepare his speech. He started wallowing in self-pity as being the unlucky human being since birth. He mentioned of being bipolar and how accepting that disorder has affected his social life. The medication did not seem to improve his condition either. So, tell me about your short story and quality of life in the face of illness. He said that he grew up as a bipolar child. His Kidneys started failing a few years ago and he was put on peritoneal dialysis before experiencing the symptoms of kidney failure. Presently, he was diagnosed with sundown syndrome. Do you know the difference between your symptoms and you true self? He fumbled something, as if being irritated then said, sometimes, sometimes. I felt emphatic but as a social worker, I was there to provide guidance. Tell me why you are adamant to continue with dialysis. He smiled, as if to hide something, and then said, "I hate dialysis, I have stage four kidney cancer and the kidney failure symptoms make me sicker. This is a terminal illness, thus no way out. The dialysis is a waste of time and financial resources for my family. I have had enough (CUSSW, 2015).
What are your desires about the kidney cancer and managing bipolar disorder? He answered immediately, "I want it all to end, now." I stood and went to his seat, touched his hand and said, I understand how you feel, however, only the continued dialysis treatment will bring this to an end. I informed him that his other medical conditions could be affecting his dialysis treatment. However, taking all his drugs diligently gives him a life expectancy of more than 10 years under dialysis. Since the client was in palliative care, I recommended to the daughter and nephew that Mr. X be given all the support that he needed to finish the treatment.
Before our meeting with Mr. X, the nurse came in to give him his medicine. He refused to take them and ordered the nurse out of his room. I thundered, medicine is excellent when one is sick. It guarantees the quick recovery. He answered, My immune system does not respond to medicine." What you mean, I asked. He said, "I have been on mood stabilizer medication for years, now dialysis, but the pain does not go away. Oh, sure! But I think that without the same medication you would not have survived this far. Once you start viewing medication as a solution and not a problem, then you will be cancer-free, as you control and finally manage the bipolar disorder. We have witnessed cases of cancer patients survive up to 30 years on dialysis. You can also do it. Are you sure? Yes, I said (Cheryl, 2009).
The interaction with Mr. X was full of learning experiences. It reminded me of my grandfather who like Mr. X, has a sundown syndrome and is bipolar. In the evening, he insists on going home, yet he is home. I was confident during the interview as I addressed Mr. X issues with acceptance and empathy as I exercised my greatest gift as a social worker, which is to contribute to working solutions. Throughout the interview, I constantly sought to understand Mr. X and used control over my attitudes and bias to maintain our relationship. Mr. X wanted did not ask for solutions to his difficulties, but instead, focused on giving up. I learned that his bipolar and Down syndrome disease had affected his stance to continue with dialysis, as he is depressed and wonders off. He still can manage his kidney failure by use of advanced treatments such as chemotherapy, use of drugs and support to live a valuable life (Gordon, 1988).
At the end of the session, Mr. X had known that his bipolar medicine was the traditional kind and desired to change into mood stabilizers medication as they assist control the highs and lows of the disease. He needs the energy to continue with dialysis and side effects of the other drugs may let him down. He agreed to continue meeting his team of oncologists, surgeons and other specialists, all of whom work on site and regularly discuss his treatment plan. The social exchange theory is suitable for Mr. X situation as he needs to undergo therapy and get educated on the importance of continuing with dialysis. The fact that its a terminal illness should not be a factor in discontinuing treatment as many have survived the disease. The interview went well as Mr. X, and his family looked to me. I hope that Mr. X does not fire his driver, as he was outraged with him (CUSSW, 2015).
Social Service Plan/Intervention Plan/Plan for Future Action
Mr. X needs to attend therapy with twice a week for medical, emotional, nutritional and spiritual needs. It will allow kidney cancer experts at Good Shepherd hospice share with him, his progress and improve the quality treatment and care. Moreover, I recommend that he be assigned a personal care nurse who will follow him during his stay and visit at the hospital during his kidney cancer treatment and after treatment is complete. As for the bipolar and sundown syndrome, he needs to change his medicines, get support from family and attend therapy (Garthwait, 2014).
Field Instructor Consultation
Mrs. Williamson and I discussed the art of structuring a helping relationship with a client. Her response was observing principles of social work and separating them from unrealistic expectations from clients. Importantly, being genuine, emphatic, giving them freedom to choose and having a counseling relationship, is a win (Gordon, 1988).
Columbia University school of social work (2015) Department of field education handbook for student social work recording: Retrieved on 2/14/2017 at socialwork.columbia.edu/wpcontent/uploads/2015/06/process_recordings_handbook1.pdf
Cheryl. F (2009). Handbook for Student Social Work Recording. Columbia University School of Social Work
Garthwait, C.L. (2014). The social work practicum: A guide and workbook for students (6th Ed.). Boston, MA: Pearson Education, Inc
Gordon, W., Guez, W., & Allen, J. (1998). Social work. France: UNESCO of behalf of Government Printer France
Process Recording Handbook. Fordham University Graduate School of Social Service. Retrieved on 2/14/2017 at
Name of Student: Your name
Client pseudonym: Mr. X
Relevant information or background for understanding interview context, e.g. age if a child, citizenship status, ethnicity: 48 years old male, American lives with daughter and nephew. They come to visit every day of the week plus weekends. Client suffers from kidney failure as he has stage four kidney cancer and refuses to continue dialysis. He is bipolar and suffers from sundown syndrome and is always moving, babbling, irritated and confused. Client takes 10mg lithium carbonate and undergoes psychotherapy. He is now in the recovery ward.
Date of interview: 2/14/2017
Location of interview: Good Shepherd Hospice
Interview Purpose: Provide the client with information to navigate the Good Shepherd Hospice and adjust to the recovery ward surrounding; and, connect him with his medical team. Give the preliminary assessment of the situation and mobilize needed services such as identifying financial resources, provide advanced care planning which entails communicating information about kidney cancer diagnosis, treatment options for bipolar disorder, life goals, values, and wishes. Further, answering client questions and attending to his personal needs while giving short-term psychological counseling to address client's refusal to continue with dialysis, irritation and moving up and down while providing the client with hope, towards a new life. Lastly, talking with client's loved ones to complete the legal documents.
Persons Present & Relationship to Client: Mr. X and I, Stephanie who is Mr. X daughter and Tim, the nephew seated next to him. Mr. X is very excited to see both of them; they are his favorites. They listen carefully as I give a summary of the session.
Prior Contact with Client: One prior face-to-face session with Mr. X.
Actions Taken to Prepare for Interview: Prepared open-ended questions before to our meeting at the recovery ward. Reviewed Mr. X's file, and discovered that he had not used Topamax or topiramate, an anticonvulsant and one of the best bipolar disorder drugs available on the market. It acts as a mood stabilizer for those afflicted with manic depression suffered by the client. I desired to know why the client refused to continue with dialysis, as such, I redirected my first questions to Stephanie who briefed me on the client's health history as Mr. X was adamant. All the information was put down in my social work internship diary, and at the same time, I took to fill the process recording template. With previous research I had conducted on life expectancy on dialysis, I informed Stephanie that Mr. X could survive for 5 to 10 years while living on dialysis as it keeps the body in balance by removing extra water, waste and salt, and prevents them from building up in the body. Again, with his bipolar and sundown syndrome condition, he must follow his treatment plan to guarantee survival.
(Exactly what was said and done during your meeting with the client; verbal & nonverbal)
Skills Use (For example, clarifying, offer empathy, use of open-ended question) Describe Your Affective Reactions While the Conversation Was Occurring
(Affective What you were feeling, i.e. your gut reactions) Describe Your Cognitive Reactions and Assessment While the Conversation Was Occurring
(Cognitive Your thoughts and evaluation)
Field Instructors Comments
W: How was your weekend?
C: As usual. Nothing much.
W: Are you anxious about continuing dialysis from next week?
C: What! No. I am not taking that treatment anymore. Nothing more or less.
W: Tell me about your short story and quality of life in the face of illness
C: (Breaths in and out.) I grew up as a bipolar child. My Kidneys started failing a few years ago. I was put on peritoneal dialysis before I experienced the symptoms of kidney failure. Presently, I was diagnosed with sundown syndrome.
W: So, where do you get the strength to cope with the disease (s)?
C: (Smiles) Frequent visits and care from my daughter Stephanie and nephew Tim, give me hope, I feel secure to face life.
W: Why are you avoiding dialysis?
C: (Laughs) The illness is terminal; I, therefore, see no need to continue with dialysis.
W: Do you know the difference between your bipolar and Down syndrome symptoms and your true self?
W: Have you educated your family and engaged them in your treatment when possible?
W: Has your bipolar condition affected your continuance with dialysis?
W: Would you say the treatment works for you
C: Pain is all I know since I started the treatment. It needs to end.
III. Interview Analysis
The interaction with Mr. X was full of learning experiences. It reminded me of my grandfather who like Mr. X, has a sundown syndrome and is bipolar. In the evening, he insists on going home, yet he is home. I was confident during the interview as I addressed Mr. X issues with acceptance, empathy as I exercised my greatest gift as a social worker, which is to contribute to working solutions. Throughout the interview, I constantly sought to understand Mr. X and used control over my attitudes to maintain our relationship.
The process recording assisted me to acquire needed information to guide Mr. X into working solution as he received his kidney cancer treatment. According to Gordon (1988) understanding your client needs, allowing adequate time to client, being genuine and listening to all underlying information is important to social work practice. Through my research, I knew that meeting a cancer patient, mainly in stage four would not be easy to convince them to continue with dialysis, s all they knew was pain. However, I felt confident in my ability to teach Mr. X and his family about the importance of continuing with dialysis, and long-term benefits such as 20 years life expectancy. The knowledge and experience gained as a social worker, gave me an edge to provide counseling, consultation and supervision as I helped Mr. X.
Throughout the interview I discerned underlying messages. When Mr. X that this is a terminal illness, I knew it was a perfect reason for him to discontinue dialysis as it demonstrated loss of hope. I believe our conversation opened his eyes to how I, his family and the Good Shepherd team of doctors trusted in him to pull through.
Mr. X wanted his family to stop worry about his health, or stretching the finances for him. He did not ask for solutions to his difficulties, but instead, showed his unwillingness to being in palliative care. I learned that his bipolar and down syndrome disease had affected his stance to continue with dialysis, as he is depressed. At the end of the session, he was willing to try out the new mood stabilizer medication to manage his bipolar disorder. I am optimistic that he will continue with dialysis s he receives support from family to live a valuable life (Gordon, 1988).
My FI has guided me on how to conduct a review on a client who is in palliative care. Mrs. Williamson suggested that I avoid telling the clients story and instead, give them time to gather their thoughts and answer. She said that I make a perfect counselor and therapist, as I knew how to fit in the client shoes, build rapport and trust that made the client discloses his difficulties to cope with the illness.
The Social Exchange Theory fits Mr. X situation he realized that even the people around him, including his team of doctors, are directly affected by his stand to discontinue dialysis, yet they had put their best foot forward to see him through during the cancer treatment and after the treatment. Moreover, his daughter and nephew are always there with him for support. This theory demonstrates how Mr. X has to make a wise choice and continue with dialysis, while taking his other medication for the other diseases. How he manages and controls his health is his responsibility. Dialysis is beneficial to kidney cancer patients, if they are patient, are willing to listen to doctors advice and are committed.
In my opinion, I was very successful in accomplishing my interview goals. I created the open door policy where Mr. X and family could ask me any questions directly and get answers. This created trust amongst us during the interview. Mr. X was very reserved and sometimes gave yes or no answers that indicated lack of interest to explore such a topic. He agreed to continue meeting his team of oncologists, surgeons and other specialists, all of whom work on site and regularly discuss his treatment plan. Since he was in palliative care, the ward was quiet and only the sound of the waterfall, outside his window could be heard. Mr. X loves nature and he looked peaceful.
I was able to use transitioning statement without confusing the client, through the guidance of my FI on benefits of good interview organization skills. I would sometime get frustrated with Mr. X reserved attitude, but Mrs. Williamson mentioned, it was okay to take a break and start over. The interview went well as Mr. X, and his family appreciated my interviewing skills that made Mr. X open up (CUSSW, 2015).
IV. Social Service Plan/Intervention Plan/Plan for Future Action (Hypothetical, if needed)
Mr. X needs to attend therapy with his doctor twice a week for medical, emot...
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