More case management questions

Exercises for Chapter 10

Exercises

These exercises can also be filled out online at CengageBrain.com.

Exercises I: What Is Wrong Here?

Instructions: Look at the following worker communications, and identify what is wrong with the way each one is expressed.

To a person who is drinking and taking tranquilizers: “That’s a risky thing to do!”
To a person who is driving without a driver’s license: “You’re just doing this to tempt fate.”
To a person who is always forgetting to take his insulin: “I’m sick of these so-called lapses of memory. You must want to feel sick most of the time!”
To a person who bounced three checks in 3 months because she cannot seem to balance her checkbook: “Go take an accounting course, for heaven’s sake!”
To the person who has lamented not spending enough time with his son: “Children are important. They grow up fast. You only have so long to spend with them when they are kids. You should keep that in mind.”
To the person who had trouble completing a high school equivalency exam and is now talking of becoming a doctor: “You need to be more realistic about what you can and can’t do. Think of some other career.”
To the woman who has completed 10 weeks in a rape victim support group and is still unable to work or leave the house much, but who says she is fine and getting over it: “It doesn’t seem to me like you’re getting over it. If you wanted to get better, you would force yourself to go out more.”
To the man who complains about his neighbors but spends time on his porch yelling at the children, which starts neighborhood feuds and tensions: “You’re always yelling at them. Of course they fight with you!”
To the woman who has been in a wheelchair for several months following an accident in spite of her doctor’s feelings that she could now be up walking with crutches: “You need to get out of that chair and practice walking. The doctor says you don’t need the wheelchair.”
To a child who says the other kids do not like him, but who is always hitting the other children and calling them provocative names: “You’re half the problem, you know. Stop yelling and hitting everyone, and they’ll like you better.”

Exercise II: Constructing a Better Response

Instructions: Now go back to the vignettes above and construct a tentative I--message that invites collaboration.

Exercises III: Expressing Your Concern

Expressing Your Concern I

Instructions: In each of the vignettes that follow, you have a problem—a concern about something affecting the client. For each of these situations, construct an I--message from you to the client. Be sure to follow the rules for bringing up your point of view. Make certain you sound tentative and ask for collaboration. Use several sentences to soften and put forth your ideas.

A woman, who has been a prostitute, recently discovered she is HIV+. She is currently staying in a shelter where you see her. Several nights she comes in drunk and tells you, “Hey, it doesn’t hurt as much this way.” The next day you approach her with an I-message expressing your concern and initiate an exchange of views.
A woman you have been working with tells you her husband is really a dear. He has done many wonderful things for her, and she is feeling guilty about calling you, but he does keep her confined to the house and slaps her a lot. You use an I-message to express your concern and initiate an exchange of views.
A man with two children needs temporary shelter. His oldest, a daughter, is old enough to drop out of school; and in the course of placing him, you learn that he has encouraged her to do just that. He tells you he needs someone at home to look after the place, now that they have one, and to see that the younger child is taken care of. You use an I-message to express your concern and initiate an exchange of views.
A woman, recently diagnosed with ovarian cancer, is using a prescription medication her doctor gave her to help her with the anxiety of facing the perpetrator in court. Lately you feel she has been abusing her medication. Her speech seems slurred, and you often see her slip one of the pills into her mouth. You use an I-message to express your concern and initiate an exchange of views.
A man has been on pain medication for a number of months, prescribed by his doctor for intractable low back pain. Following surgery he continues to feel a need for the medication although he is walking well and is pain free. When his doctor began to reduce the prescriptions for the pain medicine you learned that your client began to purchase heroin on the street. You use an I-message to express your concern and initiate an exchange of views.
A woman has not come out of her house since she suffered a major injury at work. Although her doctors say she will be able to return to work if she goes to rehabilitation, she refuses to go and cites her concern for her fragile recovery. You have talked to her many times by phone and invited her to attend support groups at the rehabilitation center where you work and to see a counselor, but she never comes, and you are becoming aware that she is terribly fearful. You use an I-message to express your concern and initiate an exchange of views.

Expressing Your Concern II

Instructions: In each of the vignettes that follow, you have a problem—a concern about something affecting the client. For each of these situations, construct an I--message from you to the client. Be sure to follow the rules for confrontation. Make certain you sound tentative and ask for collaboration. Rather than a single sentence, try using several sentences to soften and put forth your ideas.

A man who has been sitting by his wife’s side since she slipped into a coma is weary and has neither eaten nor slept for over 24 hours. You approach him with an I-message expressing your concern and initiate an exchange of views.
A woman who is refusing to take medication that would prevent her from having a psychotic episode comes to you and says she is not sure what to do. She does not feel well, but she would like to be able to handle things without medication. You use an I-message to express your concern and initiate an exchange of views.
A man whose wife just left has told you he wants to give up his job and simply leave the area, having no further contact with either his ex-wife or his children. You are concerned that he has not had time to think this through. You use an I-message to express your concern and initiate an exchange of views.
A man on your caseload, addicted to heroin, has been arrested for selling heroin to a minor. You go to see him at the county prison where he tells you that selling heroin was the only way he could support his own habit. You use an I-message to express your concern and initiate an exchange of views.
A woman staying in the shelter where you work has left her baby in the care of others repeatedly and gone out. She says she is going to the store or to look for an apartment or a job, but others let the baby lie in the crib and cry. You have had to feed and change the baby on several occasions. You use an I-message to express your concern and initiate an exchange of views.
A man is waiting for his Social Security disability check to start. He has a serious heart condition and has been told he should not be out in extremely cold or hot weather. You stop by on a home visit and discover he is out on a cold day shoving piles of snow off the driveway. He tells you it is not that cold and this is not “shoveling.” You use an I-message to express your concern and initiate an exchange of views.

Exercises IV: Expressing a Stronger Message

Instructions: In each vignette that follows, you have a problem with the behavior or actions of someone; this person’s behavior is affecting the goals of your work with the client or is adversely affecting the client. For each vignette, construct a firmer message that explicitly or implicitly requests this person’s help.

You are interviewing a man who appears to be quite delusional in the hospital emergency room. The new security officer at the hospital does not seem to understand that the behavior is part of an illness, and he keeps entering the room and asking, as if the patient cannot hear, “Is he giving you any trouble? Do you want me to take care of him?” Your message expresses your need to continue the interview and your need for privacy.
You have been working with a man who was beaten and robbed. Because of the injuries, he has been unable to work. His employer calls you several times, saying he thinks the man is simply “freaked out” and needs to get over it. The boss tells you that he has told the man this on several occasions, and says that the man just yells at him. You need the boss to understand the severity of the situation, and you feel it would be helpful if he did not keep calling the victim with his negative opinions. Your message expresses your need for the boss to work with you and the client more constructively.
You have been working with a child in temporary housing. You have discovered the child is very artistic, and you have found an artist who is willing to volunteer time to teach the child on Saturday mornings. The mother of the child is upset and tells you that it is impossible “the kid has any talent” and that “anyway, he’s got chores on Saturday morning.” Your message expresses your need to see the child’s potential fully realized.
You are interviewing a rape victim when her boyfriend barges into the room and demands, “What’s going on in here?” Your message expresses your need to continue the interview.

Note: Do not allow another person in the interview room with the client until you and the client have decided privately whether that person should be there. In other words, do not discuss, in front of the boyfriend, whether the boyfriend or anyone else can stay. Do not exchange glances with the client. In such situations, never ask the woman, in front of the man, if it is all right for the man to stay during the interview. Lead the man outside when you give him your message. Later, when you and the woman are alone, you can ask her whether she would like to have him present, but always make it appear that the decision to have him wait outside is yours. It is possible that she is afraid of him and will feel compelled to agree to his staying if she is asked about it while he is in the room. If she is fearful or embarrassed, the quality of the interview will be compromised.

An elderly woman is trying to decide what to do about her need for help. The decision is between staying in her own home with assistance, or selling her home and entering a nursing home. She is very torn. You have arranged for help, which seems to be working well, and you visit her each week. During your visits, the woman discusses with you her options. The decision is a difficult one for her. When you visit her, a woman who lives next door invariably appears and offers her advice and expresses her doubts that the woman should be living alone. Your message to the neighbor expresses your feeling that her behavior is not helpful.