Assignment 4- Overview of work with client

PREENGAGEMENT:

           In attempt to encourage Bill to be more involved with his house mates and be more socially involved at home, I instructed Bill last week to come up with an activity that the whole group could be involved in, and further instructed him that it should be in addition to baking that day.  The reason I chose this was because Bill has been withdrawing himself from all group activities in his home, and furthermore spending that time secluded in his room.  In assessing what method I could apply to him in order to get him to be more involved in group activities, I thought that by putting him in charge of the activity, not only might he be excited about it, he would have a very difficult time finding a reason not to participate.  

          I explained to Bill that I wanted to do something different when I visit him this week, and because he was showing such emotional growth over the last few weeks, I wanted him to pick the event that we would all do together.  To my surprise, he seemed pleased and excited that I have put him in charge of this task, throwing ideas out right from the start.  I told him to think about it a little longer and let me know when I see him on Thursday. 

          Upon my arrival this week, he was slightly agitated from his car ride home because he thought that his house mates were talking about him during the ride home.  During this visit I will attempt to follow the ABC cognitive behavioral model for identifying distorted thoughts and see if he will realize where his misconceptions are when interpreting stimuli.

NARRATIVE:

Bill: I know that J and P were talking about me on the ride home. And Mary (the house manager) didn’t even say hello to me when I walked in.

SW: What makes you think that they were talking about you on the ride home?

Bill: I just know they were.

SW: Okay, how about we ask them together if they were talking about you? I will go with you and help you if you get stuck.

Bill: Okay.

WE WENT TOGETHER TO ASK THOSE THAT BILL THOUGHT WERE CONSPIRING AGAINST HIM WHETHER THEY HAD IN FACT BEEN TALKING ABOUT HIM IN THE CAR.  BOTH RESPONDED SEPARATELY THAT THEY WERE NOT TALKING ABOUT HIM IN THE VAN.

Bill: I don’t believe them.

SW: Have they ever lied to you before?

Bill: Well, P has never lied to me, but J has!

SW: So if P has never lied to you, why do you think he is lying now? Did he say something or do something that makes you think he is a liar?

Bill: No….

SW: So, let’s review something for a second.  You said you heard them whispering in the van.  Correct?

Bill: Yes.

SW: So from that you thought that they were talking about you, correct?

Bill: Yes.

SW: And that made you upset?

Bill: Yes, I know they were, you are just trying to stick up for them.

SW: First, I am not sticking up for anyone nor am I on anyone’s side.  I don’t take sides. Can you think of some other things they could have been talking about that they needed to whisper?

Bill: No.

SW: They both just told you that they were talking about someone else, and it was not you.  Do you think it is possible that you misunderstood what they were doing and got upset for no reason?

Bill: I guess so, I don’t know. It doesn’t matter anymore, let’s do our project.

SW: Are you putting words in their mouths because that's what you think they said?

Bill: Well...I don't think so, maybe.

SW: Remember how sometimes you think you know what everyone is saying?  And we discussed before how you have this habit, even if they tell you otherwise?

Bill: Yes, I remember.  But I am very sensitive...

SW: It's okay to be sensitive.  But please try and remember that you have this habit, and just because you think they feel that way doesn't mean they do.  We just asked both of them if they like you, or if they were talking about you, and they both said they like you very much and were not talking about you.  Do you think that everyone is lying to you?
Bill: No.
SW: Then i think we should believe them this time.  What do you think?
Bill: Okay, can we make the birthday cards now? I really want to make them.  I don't want to talk about this anymore.
SW: Yes, of course.

IMPRESSIONS:

Bill was able to refocus his attention to making a birthday card for one of the residents in the nursing home we visited a few days prior.  He was able to admit to me that there was a possibility he was wrong, but he so strongly believed that he wasn't.  There really is no way for me to prove whether his roommates were talking about him, or how distorted his reactions actually were based on the event, because I was not there.   Despite these feelings, we were able to complete the activity he put together for the group.  The activity turned out to be very successful.  Bill was the one who invited everyone to join us, with my prompting, and was able to enjoy the rest of the time we spent together.  Everyone shared and talked nicely as we played.

At the end of our time together, I complimented him on a job well done in regards to planning an activity for the house.  In addition, I also praised him for his efforts in thinking positive and turning the situation around so that he could enjoy the activity instead of probing at the fact that he thought he was the target of the van’s conversation.  This supported my theory on how much he has grown emotionally since the beginning of our time together.

PLANS FOR THE FUTURE:

I plan on asking Bill to chose and activity for the house because I believe this will make it harder for him to stay in his room and not participate during the activity.  If he chooses it, it most likely is something that he wants to do. 

I also plan on continuing my praise of his noticed efforts to turn around his mood, as I think this will positively reinforce his behavior.  It seems as though he is not able to fully understand my attempt to point out a distorted thought, but the fact that he acknowledges the possibility that there are other sides to the story is a big accomplishment on his part.  I will not give up the attempts to show him other options despite his lack of understanding, as he is making great progress regardless.