Final Exam Biopsychosocial model

Final Exam: Biopsychosocial model

In clinical work the biopsychosocial assessment of a client is very critical in determining the client’s diagnosis. It is very important to look at factors such as the client’s biological/medical status, the client’s emotional state, the client’s social relationships and finally the cultural environment in which the client comes from. In this paper I will further explore and identify the importance of all factors included in the biopsychosocial assessment.

When assessing a client it is very important to take into account any medical problems that the client may be experiencing. This proves to be especially true in cases involving AIDS or any sort of disability. As Martin and Feeney state in their article

“ The challenges of social workers are numerous: to develop a compassionate and comprehensive response to the range of medical , psychological, social, legal and economic needs of those who have already been or will be diagnosed with AIDS, to address concerns and needs of families, friends and significant others, and though less discussed, to help professionals themselves to deal with their own emotional response to work in the area of AIDS” (pg 338). A clinician of any kind has to be aware of the fact that people who have been or will soon be diagnosed with AIDS carry around the knowledge of the negative stigma that society has attached to them. This “morally contagious” disease is usually associated with immoral activities such as drugs and homosexuality and can lead the person infected with this disease to have a number of serious psychological problems. According to Martin and Feeney, The National Association of Social Workers’ 1987 Revised Policy on AIDS states that a person with AIDS will most likely develop psychological and social symptoms similar to feelings of discrimination, depression, anxiety, social isolation, financial problems (due to the medical expenses you need to treat the disease), concern about body image, feelings of a loss of control as well as the confrontation one will have about their own mortality (pg 339). All of these symptoms are terribly frightening and confusing for the client and the clinician needs to be prepared to take on and understand the client’s needs during this difficult time.

In many cases an AIDS diagnosis does not only affect the person infected, but those close to them as well and a clinician needs to be aware of how to handle those around the infected person if need be. This is clear in Martin and Feeney’s case study of a man named Bon who was diagnosed with AIDS and his lover Tom who has to deal with Bob’s AIDS as well as his own failing health. In situations like these the clinician needs to be helpful not only to the afflicted person but needs to take into account the needs of those who are struggling around him as well. The clinician in this case study needed to also pay special attention to Tom and make sure that he could not only handle the deterioration of his lover but also needed to give him support as he explored his own failing health, which eventually turned out to be AIDS related as well. When a client is dealing with AIDS it is also very important that the clinician understand and support the client about his feelings of loss of control and fear of death. Many people with AIDS have a hard time admitting the seriousness of the disease and therefore go into a state of denial in which they refuse the help offered to them. Knowing and understanding the mentality of a person with this ailment is important in gradually increasing their ability to accept what is happening to their lives. The fear of death is also a main topic that needs to be addressed. A patient will undeniably have a strong fear and resentment of their life being cut short, and the clinician needs to be supportive but at the same time be objective when dealing these concerns of the client.

As well as AIDS, it is also important for a clinician to take into account how a client’s disability can affect their status. Esther Urdang examines this concept in great detail when describing the case study of a girl named Mary. Mary is a young Mexican American girl who is dealing with her impending blindness in one eye. She was poked in the eye by her sister when she was young and after her operation the doctors are not optimistic about her recovering sight in that eye. Mary is far behind in school because she can’t read at the level that is required for a person of her age because of her eyesight. She experiences chronic headaches and sleeps a lot during the day where she refuses to talk to anyone. It is important for a clinician to be aware of Mary’s medical condition in order to know if these problems are solely based on her eyesight or if they could be signs of depression (pg 5). Although Mary seems to cooperate well with the clinician on the outside it is important that the clinician know her medical history is affecting her and help her deal with the anxiety at possibly loosing her eyesight. Loosing one’s eyesight can be considered as a major trauma and major loss to a client as Krauz (1980) states within Urdang’s article”

“Blindness is not only an injury to the eyes; it is a destructive blow to the self-image…a blow almost to [one’s] being itself” (pg 7). Knowing this, the clinician can help make arrangements to support the client in making adaptations and arrangements on multiple levels of their life to make the process easier.

Clinicians also need to take into account the emotional and psychological states of their patients during treatment. If the client seems extremely distressed the client should immediately be evaluated to make sure there are no suicidal thoughts or tendencies. Ego functions such as perception and cognitive functions should also be assessed upon the clients arrival to assess their state of mind. According to Lettieri (2005) a person operating with normal functions of perception should have a sense of inner and outer perception. Inner perception is the capability of one to observe their own thoughts motivations and acts. Whereas outer perceptions are when an individual can interpret auditory, visual and other cues from outside the self (pp 375-380). A person in a stable and clear state of mind can distinguish between the two. Cognitive functions should also be assessed which is comprised of the ability in thinking, including remembering and the ability to associate, to differentiate and to select behaviors on the basis of anticipated outcome. This also includes the use of words in communication, logical thinking and abstract or conceptual thinking. If these are impaired it indicated that the client has a low level of ego functioning and should be assessed more in depth (375-380).

A client’s social relationships as well as their social/cultural environments can also have a large impact on their lives. The role of the client’s family plays a very important role in their current lives and treatment. As Esther Urdang states in her chapter on family:

“From a structural perspective, each family constructs its unique world, with its own rules, rituals and internal alliances, negotiating its external boundaries among its own members. The family is a self contained system; changes in one part of the system produce corresponding changes in another part. Members “dance” to patterned steps and movements, ever in synchrony, if not in harmony with the others” (pg 1). In this theory it is important to realize that if one person in the family is psychologically ill and then gets better, the family will then look for another member of the family to be the “ill” one. This is because this perspective does not focus on the individual himself but rather on how the individual affects the dynamics of the family and their communication. Urdang also discusses the idea of intersubjectivity (an object relations perspective) which believes that within a family positive or negative emotions can be transmitted from one person to another. This theory is most often exemplified in the depression of a parent where the child suffers and takes on the depression of the parent (pg 2). Problems of child maltreatment, divorce, domestic violence and substance abuse within the family can also lead to developmental and neurological impairments in developing children and adolescents.

For a client, their family’s cultural background also plays an important role in their lives. This is seen in Urdang’s chapter on family and the case study on Mary who is a Mexican American child dealing with the issue of her impending blindness. When the topic of sending Mary away to a special school for the blind that is located many miles away from the parents home arises the clinician needs to be away of the cultural differences within a Mexican American family and how that could counter the core beliefs of the family. Mexican American families put a great emphasis on the family and are more reluctant to send their daughter away from the close ties of the family. Another issue that the clinician needs to take into account is that extended members of the family will also often involve themselves in Mary’s treatment which is why Mary’s cousin is more often that not involved in the process of her recovery, which is not seen as often in our culture (pg 5).

Not only is the client and important part of assessment, but also a clinician’s level of self-awareness and disclosure. A good clinician needs to be aware of sensitive issues of the patient when dealing with their treatment as well as being able to hinder their own biases. This is seen especially in the treatment of an AIDS patient. The clinician, while dealing with the client, needs to deal with their own emotional issues concerning AIDS because although they are supposed to be objective they cannot always hinder their own biases and reactions towards the disease. The clinician will sometimes even deny they are working with AIDS patients for the fear that the negative stigma will also be placed on them. While the clinician’s own biases are an important factor, the issue of boundaries is also important to consider because the line can easily be blurred and boundaries overstepped if the clinician is not careful. An example of this can be seen in Martin and Feeney’s article when discussing Bob’s case study. Bob is a middle aged gay man who is dealing with his AIDS diagnosis and for the beginning part of his treatment is in great denial about the seriousness of his disease which often led him to refuses help from others. One night upon his discharge from the hospital Bob realizes that he is incapable of making dinner for himself. He is caught in a bind because he does not have any friends who are able to help him and he has refused any professional help. When hearing this, the social worker agrees to come over that night to cook his dinner for him. While this is an extremely altruistic gesture the clinician needs to be careful where she should draw the line. She needs to make it clear to Bob that she is doing this out of friendship but at the other end she needs to make sure he realizes this can’t be an often occurrence because if she perpetuates this type of behavior it’s as if she is cementing his idea that he does not need any professional assistance. This level of self awareness is crucial for the clinician in a situation like this (pg 340). A clinician also needs to be aware of their own opinions and the ramifications that may arise if they share that opinion. An example of this is also shown in Martin and Feeney’s article when Bob is steadfast in his decision that he will not tell any of his friends about his diagnosis of AIDS for fear that they will abandon him. The clinician needs to be aware and careful how she approaches this issue; on one side if she advises Bob to tell his friends and they do in fact abandon him she does not want Bob’s anger and blame to be focused on her. But on the other hand if she constantly agrees with Bob in his decision of not telling his friends and family it’s as if she is further perpetuating his denial of his failing health and enforcing the idea that if he tells his friends they will in fact abandon him which will only lead to further isolation (pgs 343-347).

Confidentiality and disclosure are other topics that a clinician has to be very aware and cautious of. As stated in Murphy and Dillon’s Interviewing in Action, when a clinician first starts to see a client they are obligated to inform the client of their confidentiality rights and limits. Only under certain circumstances is the clinician allowed to break a client’s confidentiality. The circumstances include: if the client is at risk for harming self or others, there is possible neglect or abuse of children, or possible abuse or neglect of elderly people (pg 45). Although it may seem appropriate at times, the clinician is never under any circumstance allowed to break confidentiality based on their own opinions or biases or concerns. An example of this is shown in Martin and Feeney’s article when the social worker was at Bob’s apartment and was caught by surprise when Bob’s parents walked in, who did not know about Bob’s illness. Although the social worker felt it was best if Bob told his parents, it was not her decision to make and protected his confidentiality by introducing her self as a social worker who was there to help set up Bob’s home care (pg 342).

When thinking of my own possible future as clinician, there are two aspects of my development that I would like to work on in supervision. The first aspect that I would want to work on would be hindering my own biases and opinions that I might have towards a client. For example if I was seeing a woman who was continuously being beaten by her significant other I would have a hard time keeping my opinions to myself and not telling her to get out of there as fast as she can. I need to work on finding a productive and influential way of letting the woman come to this decision on her own and work on the issues she has that is preventing her from leaving. Basically, I need to work on emotionally removing myself and my opinions from my clients. Another aspect that I would like to work on would be how reluctant I am to push the client to say anything too personal. Although I realize that at first this could be a good thing because I client needs to open up in their own time, I think that I am too considerate of people’s privacy and therefore I feel rude if I ask for too much personal information. I need to work on a way in which I can find a healthy medium where I can still slightly push a client to get them to open up but at the same time maintain my respect for their privacy. In conclusion I have realized over the course of this class how much thought and effort goes in to the field of clinical psychology and that it is not as simple as it may seem. The clinician not only has to keep in mind the needs and mindset of their patients but also maintain a level of self awareness as well.