Running head: CASE ASSESSMENT 1

Kathryn Murray

Case Assessment

Dr. Li

Foundations of Clinical Social Work Practice

April 24, 2017

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Sergio and Richard have been together for fifteen years, they consider themselves life

partners. Sergio and Richard parent two children together, a five year old daughter and a three year

old son. They are of two different cultures. Sergio is from Brazil and is Catholic and is currently

living in the United States undocumented. Richard is from Philadelphia. While growing up Richard

identified as Jewish, but now identifies as Atheist. This case presents itself as one that fits several

diagnoses and personality theories for each married individual and their relationship as a married

couple. It is important to understand this couple through their individual schemas in order to

effectively diagnose and label personality theories and interventions for them as a couple.

Engagement & Assessment

In order to identify mutually agreed upon intervention goals and desired outcomes with

the clients, I will begin by allowing both Richard and Sergio to answer the miracle question from

the brief, solution-focused model. The miracle question includes asking “if you woke up and all

of your problems were solved, how would things be different when you woke up?” Through the

miracle question I will be able to discover each person’s perspective and what their top priorities

are so we can collaboratively decide on what intervention goals and desired outcomes will best

suite them.

According the clients’ presentation and the Diagnostic and Statistical Manual, diagnoses for

Richard could include depression and alcohol use disorder. According to the DSM-5, you must

meet at least two of the listed criteria within a year to be considered to have a problematic pattern

of alcohol use (American Psychiatric Association, 2013). According to Sergio, Richard meets two

of the criteria for possible alcohol use disorder including “alcohol is taken in larger amounts or

over a longer period than was intended” and “continued alcohol use despite interpersonal problems

caused by alcohol” (American Psychiatric Association, 2013, p. 233). From the information
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presented, Richard does not qualify for Major Depressive disorder (MDD) because he does not

possess five or more of the symptoms required for MDD (American Psychiatric Association, 2013,

p. 233). Although he does not meet the requirements for MDD, I will continue to be cognizant of

the symptoms that he does have while gathering more information.

Diagnoses that may be present within Sergio include depression and/or adjustment

disorder. Sergio stated that he is feeling, “unappreciated and profoundly sad” which could indicate

that he is suffering from depression. However, there is not currently enough information to

diagnose Sergio with depression, but in future sessions he needs to further evaluated. Sergio could

also be experiencing an adjustment disorder which consists of the, “development of emotional

symptoms in response to an identified stress occurring within 3 months” (American Psychiatric

Association, 2013, p. 151). In this diagnosis Sergio’s cultural setting should be taken into account.

This diagnosis also needs to be further explored in future sessions to identify if the diagnosis is

present.

Both Sergio and Richard have strengths and limiting factors both individually and as a

couple. Sergio’s strengths include strong religious ties, working a part time job, and cares about

his family’s well-being. Richards’s strengths include having an accepting relationship with his

parents, being protective of his children, and being sympathetic of Sergio’s concern towards

having no legal custody of the children. As a couple, their strengths include caring enough about

their family to seek counseling to improve their relationship, their ability to communicate what

issues they want to work on in therapy, their ability to endure a bicultural relationship, and they

are able to provide for their children.

Sergio’s limiting factors include his undocumented status, his sad feelings he has been

experiencing which have been hindering his ability to cope, and his feelings that he is unable to
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share with his family that he is homosexual. Richard’s limiting factors include taking the loss of

his job hard, not being open to his partners religion, and his alcohol consumption is increasing

conflict within the relationship. Limiting factors as a couple include an escalation of conflicts over

the past few years with an inability to problem solve or compromise.

Issues of Diversity, Human Rights, and Justice

Ethnic, social, and cultural influences have impacted both Sergio and Richard’s

development. Sergio was born and raised in Brazil and identifies as catholic. Although he has been

in America for fifteen years, it is evident that Sergio still takes pride in his Brazilian culture. His

development and personality are reflective of his childhood and his emphasis on collectivist

values. This is evident in Sergio taking over the responsibility of his younger siblings after his dad

passed away and his hopes to improve his relationship with Richard to strengthen his relationship

for his children. Despite recent developments of same sex marriage in Brazil, homosexuality is

still not widely accepted (Ogland & Verona, 2014). Therefore, due to cultural and social

influences, Sergio has still not told his family about his partner Richard. These ethnic, social, and

cultural influences have impacted Sergio’s personality and development by hindering his ability

to be open about being gay to his family.

Richard has lived in the United Sates his whole life. The U.S. is an individualistic culture

that has currently legalized gay marriage in all states. Richard comes from an open family who has

accepted his homosexuality and is also open to him changing religions from Jewish to Atheism.

Richard’s ethnic, social, and cultural influences have impacted Richard’s personality and

development by allowing him to live freely and openly in regards to his sexuality and religion

preferences which have led to his ability to be open, honest and direct about his thoughts and

feelings as an adult.
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As a social worker, my own cultural identity could influence the choice of theoretical

approach I chose to use. As a white, female, from an individualistic culture, this could influence

my choice of theoretical approach that I choose to implement. But, as a social worker, I must be

cognizant of proper theoretical approaches to use with clients of differing cultural identities to

ensure that I am incorporating approaches that are most beneficial to my clients and are culturally

sensitive. It is important to also be cognizant of the social and/or economic justice issues that my

clients face in order to properly advocate and assist them in the therapeutic process.

Both Sergio and Richard have been affected by a lack of social and/or economic justice.

Sergio has been affected by a lack of social and economic justice through his undocumented status

which contributes to his inability to find a steady job with full time hours and his inability to legally

adopt his own children. Richard has also been affected by a lack of economic justice. After being

laid off he is struggling to find a new job which is increasing the family’s economic hardship. As

a couple, Sergio and Richard face social justice issues by being a bi-cultural and homosexual

family. Due to gay marriage recently being legalized in the United States, many people still see

the subject as controversial and morally wrong. This would undoubtedly increase stress within the

family for both Sergio, Richard, and the children.

As the clinical social worker it is my duty to advocate for human rights and justice for my

clients. For Sergio and Richard, I will assist them in providing resources and information on

actions the couple can take to address Sergio’s undocumented status. If my clients feel they are

being discriminated against due to their bicultural and homosexual relationship, as a social worker

I must help Sergio and Richard to address these injustices to improve their quality of life.

Addressing these injustices by advocating for my clients could potentially affect their lives by

decreasing the stress that they are feeling and help them feel empowered during this difficult time.
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Ethical Considerations

As a social worker, my own personal values may influence the choice of theoretical

approach I choose to implement. For example, my personal value of openness could result in

choosing a theoretical approach that relies on directness and openness of clients. This could affect

my rapport and therapeutic relationship with a client whose culture does not agree with openness

and directness, especially so early in the therapeutic relationship. To avoid value imposition, I

must be able to recognize my own personal values and limitations as a social worker and be

knowledgeable about theoretical approaches that are more applicable to different cultures.

Social work values that should guide a social worker’s theoretical approach include the

National Association of Social Workers (NASW) value of competence and dignity and worth of

the person. The value competence states that, “social workers continually strive to increase their

professional knowledge and skills and to apply them in practice” (National Association of Social

Workers, 1999, p.2). By increasing your professional knowledge and skills of different theoretical

approaches you will be more equipped as a clinician to incorporate the best theoretical approach

for your client. The value Dignity and Worth of the Person states that, “social workers should be

mindful of individual differences and cultural and ethnic diversity” (National Association of Social

Workers, 1999, p. 2). This value also states the importance of knowledge of cultural diversity when

picking theoretical approaches to use with clients. These values reinforce that not all cases are the

same and each client is unique, therefore social workers must be knowledgeable of different

theoretical approaches that best suit each client’s needs.

Ethical considerations for this case include Sergio’s undocumented status and the couple

potentially feeling embarrassed for seeking counseling. While working with the couple, I must be

mindful of Sergio’s undocumented status, drawing attention to Sergio could result in deportation.
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Due to Sergio’s cultural background additional barriers could possibly be the embarrassment of

seeking counseling. I intend to be mindful of these ethical considerations when working with my

clients and with the permission of my clients I plan to seek outside help from other professionals

if needed.

Application of Theory

The personality theories that apply to Sergio and Richard’s case are Erik Erikson’s Human

Behavior Theory’s and Aaron Beck’s Cognitive Theory. Erick Erikson’s Human Behavior

Theory’s focuses on eight stages of development which are extended to all ages of life (Kelland,

2014). Unsuccessful completion of any of these stages could result in problems in the future

(Kelland, 2014). I selected this theory because there are two particular stages Identity vs. Role

Confusion and Generativity vs. Stagnation that are applicable to this case (Kelland, 2014).

Identity vs. Role Confusion is the fifth stage and occurs during adolescence (Kelland,

2014). In this stage adolescents are allowed to explore and learn about themselves as individuals

which results in the formation of identity (Kelland, 2014). If this does not occur, role confusion

can result (Kelland, 2014). This development stage is particularly applicable to Sergio who had to

take on the parental role of helping raise his siblings after his father’s death at the age of thirteen.

Instead of taking the time to explore his own individual identity, he had to take care of his siblings

instead. Due to Sergio’s inability to form his own identify he developed role confusion. This role

confusion ultimately affected his personality and development by hindering his ability to make his

own choices and feel in power of his own life. Sergio’s unsuccessful completion of the stage

Identity vs. Role Confusion explains his lack of development of forming his own identity which

has resulted in his inability to be open and honest about his sexual orientation with his family.
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Richard appears to be currently struggling in the Generativity vs. Stagnation. This

development stage occurs during middle adulthood and is a time when the home environment that

was created comes first before any other social institution (Kelland, 2014). Generativity is, “the

concern of helping establish and guide the next generation through productivity;” stagnation

results when generativity fails (Kelland, 2014, p.150). Richard is currently experiencing

stagnation because he cannot fulfill the financial needs of his family after being laid off from his

job. As a result, Richard views the loss of his job as a personal failure because of the economic

strain it has put on his family. Richard’s struggle with stagnation explains his change in personality

since the loss of his job which has contributed to his increased alcohol consumption.

Another theory that is applicable to this case is Beck’s Cognitive Theory. Beck’s Cognitive

theory is based on automatic thoughts, schemas, and cognitive distortions (Kelland, 2014)

Automatic thoughts are a person’s immediate view of a situation that occurs and are a result of

schemas which are “stable cognitive patterns of interpreting situations” (Kelland, 2014, p. 263).

These schemas are the result of cognitive distortions (Kelland, 2014). I believe this theory is

applicable to the case because both Sergio and Richard appear to experience cognitive distortions.

Richard appears to experience dichotomous thinking which is seeing events as right or wrong

(Kelland, 2014). This is evident in his refusal to allow his children to be exposed to his partner’s

religion. Sergio could possibly be experiencing overgeneralization through his view that Richard

does not cares for him “like he used to” because of the issues they have been having.

Both of these theories appeal to me professionally because they both address the couple’s

differences in childhood, cultural differences, and distorted thinking that have been putting a strain

of the couple’s relationship. They also appeal to me because they assist in identifying the unique

needs and strengths of each client individually, and as a couple.

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Erikson’s stages of development addresses Richard’s strengths of coming from a

supportive family, but it also addresses Richard’s limitation of struggling through the stage

Generativity vs. Stagnation after the loss of his job. Sergio’s strengths consist of his caring nature

to help his family at such a young age, but his limitations are not taking time for himself, resulting

in role confusion. Beck’s Cognitive theory also addresses Sergio’s and Richard’s limitations and

strengths. Richard’s limitations are his dichotomous thinking and Sergio’s limitations are his

overgeneralization. Richard and Sergio’s strengths as a couple are their ability to communicate

their feelings.

These theories are relative to the significance of ethnic, social, and cultural factors affecting

the clients. Erikson’s stages of development addresses the couple’s struggles through the phases

of Identity vs. Role confusion and Generativity vs. Stagnation which will aid in demonstrating the

differences that social and cultural factors have played on each person’s personality and

development. Beck’s cognitive theory will also assist in addressing these differences though

helping the couple identify cognitive distortions that may have been developed in their own

individual ethnic, social, and cultural background.

Intervention

The evidence based practices of Adlerian Psychotherapy and Cognitive Behavioral

Therapy would be effective in informing decisions about how to intervene with the clients. Duba

& Watts (2009) research states that Adlerian Psychotherapy has been proven effective in working

with people with Catholic faith and couples with differing levels of faith because it, “highlights

the importance of understanding one’s lifestyle and how that affects one’s relationships” (Duba &

Watts, 2009, p.214). Adlerian Psychotherapy seeks to understand an individual’s style of life to

help the client identify and change “mistaken styles of life and goals they have been pursuing”
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(Kelland, 2014, p. 102). This would be effective for both Richard and Sergio because it has been

proven effective with couples that have differing levels of faith and also because it helps the

couples recognize goals that have been counterproductive to the health of their relationship (Duba

& Watts, 2009);(Kelland, 2014). Although Adlerian Psychotherapy offers the couple interventions

that could be valuable, Cognitive Behavioral Therapy Interventions prove to be better suited

interventions to address the couple’s needs.

Cognitive Behavioral Therapy (CBT) challenges negative thinking and encourages

positive thinking while contending to both cognitions and behavior (Patterson, 2014). CBT would

be beneficial to the couple because it would be effective in addressing both Richard and Sergio’s

individual cognitive distortions which have contributed towards the cognitive distortions of their

relationship. Being able to recognize these thought patterns will aid the couple towards “modifying

thinking that is more consistent with desired behaviors” (Patterson, 2014, p.2). I believe CBT

would increase optimal quality of life for Sergio and Richard because it offers a wide range of

interventions with the goal of reducing symptoms and increasing function (Hofmann, Asnaani,

Vonk, Sawyer, & Fang, 2012). This would prove to be most beneficial for Sergio and Richard to

increase the functioning within in their relationship and to reduce their symptoms of profound

sadness and resentment in order to be a united front for their family. Since Richard and Sergio are

the experts, CBT would also prove to be beneficial because it allows the patient to be an active

participant in the, “problem-solving process and in challenging and modifying maladaptive

behavioral patterns” (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). Being an active

participant would greatly help Sergio and Richard by restoring their confidence in their ability to

handle conflicts.

Termination & Evaluation

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In order to facilitate positive endings with these clients after each session and after

termination I plan on implementing reflection and summarization. I will use reflection to help

assist my clients in identifying emotions expressed in their statements and to assist the client in

reframing the issue they are discussing. By implementing reflection, I can explore the client’s

messages while leaving clients feeling understood. I will also implement summation skills to help

review the focal points of the session and to help the client focus on key messages throughout the

sessions. Implementing summation skills correctly will help end the session on a positive note by

recapping what was said during therapy along with reiterating the strengths and progress made to

help increase the client’s confidence in their ability to handle the conflicts that they face.

Models of outcome evaluation to assess client progress and analyze the effectiveness of the

intervention could be applied by the social worker through evaluative self-report surveys or

through implementing pre and post measures. An evaluative survey provided at the last session or

mailed/emailed to your client after termination would help measure client satisfaction and

outcomes with the services they were provided. Another way to evaluate outcome to analyze

effectiveness would be to provide a self-report survey prior to services and then apply the same

self-report survey again after termination. Measuring functioning and wellbeing before and after

services will demonstrate any changes that occurred as a result of therapeutic services.

Summary

The case of Sergio and Richard comes with many ethnic, social, and cultural factors that

need to be taken into consideration when working with the clients, both individually and as a

couple. By examining theoretical perspectives and interventions that are applicable to the case I

was able to determine the strengths and limitations of each perspective and make an educated

decision on incorporating CBT as the intervention process. When working with a client, it is
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important to keep in mind the client’s strengths, limitations, culture, and social and economic

justice issues that they may face. It is also crucial to be able to recognize the biases that your own

cultural identity could play on your use of interventions. What theoretical perspectives and

interventions work best for you as a professional may not be what is best for your client. It is

important to remember that every client is unique which is why as a social worker you must be

knowledgeable of theoretical approaches, assessments, and interventions that prove to be most

beneficial to the client you are serving.

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC.

Duba, J. D., & Watts, R. E. (January 01, 2009). Therapy with religious couples. Journal of

Clinical Psychology, 65, 2, 210-23.

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (October 01, 2012). The

Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive

Therapy and Research, 36, 5, 427-440.

National Association of Social Workers. (1999). Code of ethics of the National Association of

Social Workers. Washington, DC. NASW Press.

Ogland, C. P., & Verona, A. P. (September 01, 2014). Religion and the Rainbow Struggle: Does

Religion Factor Into Attitudes Toward Homosexuality and Same-Sex Civil Unions in

Brazil?. Journal of Homosexuality, 61, 9, 1334-1349.

Patterson, T. (June 06, 2014). A Cognitive Behavioral Systems Approach to Family Therapy.

Journal of Family Psychotherapy, 25, 2, 132-144.