Case Study: Treatment Plan
The objective of social work in all cases is to improve the quality of life of the client by understanding their needs, recommending and implementing interventions that would help realize the intended outcomes. As such, social work intervention can never be complete without beginning with the client needs. As a case manager, the first step in dealing with a client is to understand the client’s status during presentation, both spoken and unspoken. The case of Master Sergeant Thornton therefore requires similar consideration. As the case manager, it is required that through interactions with the Sergeant and with those close to him, it will be possible to clearly define his needs and to set the intervention goals and objectives. The ensuing treatment plan provides a description of the observable client needs, the services that can be used to address those needs and the strategy that will be used to address the needs. A multidisciplinary approach to social work is mandatory for satisfactory case management since the client may be having several needs that cannot be fulfilled by a single professional.
Dover (2016) reported that social work is intricately connected to the responsibilities of the social work profession and of social welfare in terms of satisfaction of human needs. Social workers have the primary objective of enhancing human wellness by meeting the basic human needs of all populations. In most cases, social workers deal with the oppressed, and the vulnerable. For Sergeant Thornton, classification social work comes in as a form of intervention for vulnerability in that the experiences of the client during service have significantly affected him to an extent that he has become deficient in meeting some of his needs. As the case manager, an exploration of the client’s needs was conducted based on the information availed through direct communication with the client as well as with his family and friends as the primary sources of information. Close observation of the client behaviors was also used as a secondary source of information on the client needs.
For Sergeant Thornton, psychological needs can be described as the most important and most in need of urgent addressing. Psychological needs affect the thought process of those considered deficient and are a result of experiences that the victims have had in the past. The client here has been in a war environment in which he lost many friends, including a close childhood friend. The impacts of those experiences on his life, though not physical, are sufficient to destroy his entire life and even to result in physical symptoms. By addressing the psychological needs for the client, his self-management will be made possible, resulting in better emotional, physiological and even social care. The specific psychological needs portrayed by the client are indicated by insomnia, night mares and frequent flashbacks of the happenings at the war front (Bushman, 2017). These symptoms are some of the basic signs of post traumatic stress disorder, which is highly prevalent among veterans. The client therefore needs to be guided to come to terms with his experiences through a guided grieving process that would help him to deal with the loss of his friend and also to improve on the symptoms.
Cognitive behavioral therapy is the recommended form of intervention for individuals suffering from post traumatic stress disorder (Bushman, 2017). This form of therapy is offered by counselors and can be done in groups of other veterans with the same symptoms or as an individual. In this case, Sergeant Thornton would be referred to a veteran counselor. The choice of professional is based on their probable experiences dealing with the condition specifically among the population to which Thornton belongs. Several facilities are available across the country to offer these services and it is recommended that he visits VA Healthcare (U.S. Department of Veterans Affairs, 2019). Professional counselors from these facilities can thus be approached on behalf of this client, consulted for their service flexibility and have him signed up for therapy. While undergoing therapy, it will be prudent for Sergeant Thornton to consider the story of Job in the Bible. As much as he had lost everything both socially and materially, Job remained strong enough to push through his struggles. His losses did not drive him to abandon his people or responsibilities in spite of the negative advise from friends and relatives.
Besides the psychological needs, Thornton also has serious social needs that will require intervention to address. The social needs can also be attributed to the psychological challenges he currently has. The post traumatic stress he is experiencing has driven him to anti-social behaviors such as irritability and discomfort with everyone. The client’s antisocial behaviors have in effect resulted in strained inter-personal relationships even between him and his other friends, strained family ties, and even a terse work environment. Sergeant Thornton’s anger and irritability have driven him apart from his wife, resulting in a strained marriage as well. Social needs are important to be met for anyone suffering from post traumatic stress disorders. A strong social system provides significant support for affected individuals and getting this kind of support can foster faster psychological healing, hence the need for Thornton’s social needs to be met (Bachrach, Pfister, Wallis, & Lipson, 2014). However, the fact that those who were previously close to him have already concluded that he ‘has lost it’, building that strong social system will require more challenging work to be done.
The best solution to meeting the social needs would be to have social support groups for those close to the client. According to Dover (2013), effective management of the client can be achieved if the social worker identifies a few individuals who can be counted on to provide strong social support to the client. A counselor or even the case manager can be able to communicate to Sergeant Thornton’s family and his unit leaders. They need to be made to understand that the sergeant needs their unending support and guidance. On the other hand, the client will be able to satisfy his part of the social relationships only once he has received intervention for the psychological needs and the outcomes are clear. Again, a strong support system is recognized from a biblical perspective as a factor that contributes to healing in times of psychological trouble (Bachrach et el., 2014). Examples are available in the story of king David who spent days mourning, praying and fasting for his son to be saved from illness, Job and his friends who were there to cheer him on even though they gave unacceptable advise; and even Jesus and his disciples who were with him at a time of distress in preparation for the arrest.
After the psychological and the social needs, the emotional needs for the client are the most important. Moods and anxiety issues are the most common emotional needs among veterans, and Sergeant Thornton has displayed signs to show that he also may be having emotional needs. The most pronounced symptom is mood instability, seen in his tendency to be irritated, frequent anger, anxiety about everyone’s motives for the war and their lack of consideration, and even anger at himself for not focusing enough on the war. He is also angry at anyone who confronts him about his emotional issues hence the argument that he has lost it. Building strong interpersonal relationships can only happen in the absence of negative feelings about others and with willingness to collaborate with others through communication. As such, dealing with emotional needs will be a precursor to building strong social systems for the client both at work and at home. Those close to him need to feel wanted and this can only happen if the client learns to control his moods rather than letting them control him.
Accordingly, a cognitive behavioral therapy is recommended for dealing with emotional needs for the client. The same counselor can handle both emotional and psychological needs since the emotional needs could be taken as part of the symptoms of the psychological needs. Consequently, the best facility for assistance should be the U.S Department of Veterans Affairs, which can recommend professionals for referral. Dealing with emotional needs will be a fulfillment of Biblical teachings on managing anger. In the book of Proverbs, the Bible teaches that no one should go to bed angry. Additionally, anyone who lets anger control him/ her allows the devil to take control of him/ her. In the New Testament, the Bible teaches that no one should worry or be anxious about anything and that instead, people should pray. Each of these teachings corroborates the need for emotional stability, which will only be fulfilled in this client through cognitive behavioral therapy.
Physiological needs come about as a result of the other needs that the client is currently experiencing. In this context, the physiological needs would be described as those needs that are directly linked to the physical body. Physical health is an essential part of human health, and no one can be described as truly healthy without being physically fine (Oster et al., 2017). Activities which result in poor physical health therefore indicate a deficiency in physiological needs which has to be addressed. For Thornton, these deficiencies are described through symptoms of fluctuations in appetite, excessive drinking and difficulty in sleeping. Poor physiological activity in those areas can have significant negative effects in other dimensions of life including psychological and emotional health. For instance, Privitera, Misenheimer, & Doraiswamy (2013) have shown that appetite fluctuations can affect moods and can also result in physiological outcomes such as obesity. Other symptoms such as insomnia can affect career growth due to impacts of sleep deprivation on moods, cognitive functioning and productivity. Similarly, excessive alcohol consumption can have psychological and social impacts, which may flow into the work place.
The physiological needs of concern in this case can be deduced to be behavioral. Substance use disorders, insomnia and appetite fluctuations can be attributed to patterns that have been developed over time as a result of the psychological experiences that the client is going through. For the physiological needs therefore, the case will be referred to various professionals. The Substance Use and Mental Health Services Administration (2016) recommended the use of medications to avert substance use disorders through primary healthcare facilities. Similarly, sleep deprivation and appetite disorders can be treated through behavioral therapy. The Bible cautions against excessive consumption of alcohol in several verses, clarifying that excess drink should be left to fools and those who are dying. Similarly, the Bible provides guidance of commendable eating practices, encouraging people to eat and drink and enjoy life in moderation. The interventions in physiological needs for the client therefore fulfill Biblical teachings.
Religious needs are the fifth most important in the case of Sergeant Thornton. Religion helps in developing values and principles by which one lives. Lacking a strong religious foundation can result in misguided beliefs. For instance, the officer here has confessed that his experiences have made him to doubt God’s existence and even to blame God for his loss. Additionally, it can be deduced that actions such as playing video games continuously and watching pornography instead of focusing on productive activities are attributable to loss of direction and priorities in life. It is important that the client understands that God’s intentions are noble and that everything occurs with a reason. He also needs to understand that man’s final fate is death and that no one can be blamed for it. The best person to offer guidance in this regard is the unit chaplain. Sergeant Thornton needs to understand that God’s will is perfect and irrevocable. It is only in this way that he can get to reconcile his Christian beliefs and to walk on the right path. The Bible also teaches that the dead have no oneness with the living and that people should mourn but not extensively. He should therefore grieve in moderation and allow his friends to rest since death is inevitable. Understanding this from the Biblical perspective under the guidance of the chaplain will therefore help Sergeant Thornton to restructure his religious beliefs.
While career needs may not be as explicit as the other needs, they are important in this context since the client in question may ultimately be affected beyond professional performance. He needs to understand how all these other needs are affecting his career and the possible implications they may have in the long run. For this, Sergeant Thornton needs the advice of a career counselor or general counselor in the military. He needs to stay at work for the long term since the Bible also discourages laziness. Sloth is listed among the seven things that God hates and cannot tolerate. He should therefore be guided away from practices that foster laziness such as excessive drinking, constant gaming and idleness.
Summary and Conclusions
Sergeant Thornton’s main issues stem from the psychological needs he is currently deficient of. The psychological needs however arise as a result of incubated grief, which he needs to let go of and deal with the future issues in life. As a result of his experiences during deployment, the client has developed post traumatic stress disorder, which is symptomatic through various aspects of his life. For instance, he experiences, insomnia, mood swings, anxiety and appetite fluctuations among others. Each of these outcomes can be categorized under a different type of need, which requires a different form of professional help (Havemen-Gould & Newman, 2017). As a case manager, I would first refer the client to a professional veteran counselor to help deal with his psychological and emotional needs. This could take up to 6 weeks. I would then refer him to the chaplain to have his religious needs addressed. The social, physiological, and career needs should be met automatically with little input from the counselors once the psychological, emotional and religious needs are met. The whole process can take up to six months.
While under treatment, the progress of the client will be monitored by the respective professionals at different levels. As the case manager, the main indicators of progress will be based on the physiological and social outcomes of the process. Behavioral patterns in sleep, eating habits, alcohol consumption and interpersonal communications will be recorded on a bi-weekly basis. More stable appetite patterns, regular sleep, reduced alcohol consumption, better social interactions and greater career focus will be taken as indications of positive progress.
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