Case Study: Personal Boundaries In The Workplace
The case scenario allowed me to appreciate the principle theme of working with working with elderly PT’s who have experienced trauma and making the worker feel like a grandchild. Other surrounding themes presented in the case which included, transference and countertransference, intergenerational, Ageism and boundaries.
My initial reaction to this case scenario was that I felt that there was some sort of connection between Mr. Hansen and I, and that I felt that I was essentially crossing personal boundaries with him. These boundary crossings were manifested by checking up on him many times a day and answering personal questions related to remembering the Jewish history of Holocaust. Additionally, after leaving the Mr. Hansen’s room I would …show more content…
feel a sense of responsibility to retell story of the Holocaust and to learn from it.
The litterature shed light on the reasons that Mr. Hansen was so persistent on passing on the Jewish history of the Holocaust specifically the article written by Lev–Wiesel (2007). Unfortunately, I found that there is only a burgeoning amount of literature around the theme of working with elderly clients of holocaust survivors and feeling like a grandchild. Fortunately, Lev–Wiesel’s article highlights the incidence of individuals that experienced trauma and its impact across three generations indicated in her article that each member of across three generations expressed a common mission, which was “to remember the holocaust, never to forget, and to transmit this charge to coming generations” (2007, p. 83). This phrase was truly an eye opener for me as it enabled me to appreciate Mr. Hansen’s perspective by understanding the reasons that he wanted me–the third generation–to remember holocaust. At first, I felt that re-telling the Holocaust was a responsibility, and that it was something that was weighing on my shoulders. However, after much reflection, I realized that he was simply teaching me or transferring the idea to learn about the importance of this event in Jewish history and never to forget it. The literature shed light on how important it was for the holocaust survivor to tell this Jewish worker to remember the Holocaust. Similar to a grandfather that would tell their grandchild to remember the holocaust, this PT treated me as their granddaughter. This literature made me understand the reason that he was so persistent in reminding me of his Holocaust experience, the importance of never to forget it and to pass it on to future generations.
The theme of transference and countertransference can impact the counseling relationship in a positive or a negative way. Transference occurs when feelings that the client or PT have for one person are unconsciously redirected to another (Stern, Smith & Frank, 1952). Countertransference is the concept of a PT redirect feelings meant for others onto the therapist (Stern, Smith & Frank, 1952). The transference in this case, was the fact that the counselor and the PT both shared a similar social context, specifically the fact that we both identified with Judaism. The fact that we were able to bond due to sharing similar social contexts, may have facilitated the transfer of feelings regarding the importance to never forget the Holocaust and to pass it on to next generations. Stern, Smith & Frank state in their article that “in work with old people, the physician or the social worker is often considerably younger than the client and could be the client’s child is apt to modify the common situation of transference” (p. 328). As indicated by Stern, Smith & Frank, “the most common transference relationship between physician and PT is that of the "parent- child" type” (1952, p. 328). Growing up without a father in the home, it may be that I facilitated the countertransference by accepting the grandchild position and doing actions in order to make him “proud”. This need to make him proud was expressed by following up with him 3-5 times a day and answering his personal questions.
On my part, I felt that personal boundaries were crossed when working with this client, however, I felt that these boundary crossings were appropriate for the therapeutic relationship.
The fact that the PT and I shared this bonding, I felt that I crossed certain professional boundaries in doing everything in my power to make things easier during his ICU admission. I questioned myself many times asking myself “am I doing the right thing?” As I knew that checking up on the PT 3 times a day and buying a menora was not something I provided to all my PT’s. However, I felt that I was and my gut feeling told me that despite crossing these boundaries I provided the Mr. Hansen with best service before his last moments in this world. Reamer (2013) states that “a clinical social worker’s modest self-disclosure or decision to accept an invitation [...] may prove in some special circumstances to be therapeutically useful to a client” (p. 123). Alternatively, “boundary crossings are harmful when the dual relationship has negative consequences for the social worker’s client or colleague” (p. 123) And for me to have shared those final moments with him was both an honor and a learning experience. A learning experience that I took from saying that even though I did cross SW boundaries, it was appropriate because I felt that I provided him the best service he needed at that time and our social context allowed us to
bond.
Ageism is another theme present in this case, as I felt that the team was discriminatory to the needs of the PT. I met Mr. Hansen during rounds, when the ICU team was discussing the PT in front of Mr. Hansen’s room. I found the teams’ language was dismissive and disrespectful as the patient was apt (even though it may not have been so visible) and was hearing the words expressed by the team. An example of this dismissive language was that the team referred to him as “difficult” and “time consuming” and as if he was not present or listening. Ageism can be described as “regard[ing] older people as one homogeneous group rather than a range of individuals with a variety of experiences, interests, and needs, [...] can result in ageist attitudes and practices” (Duffy, 2011, p. 110). Language has a significant impact on the way one percieves the individual. The team should view elders as individuals that are wise and with lived experience. On a more critical lens however, doctors are dismissive with almost all the PT’s in the hospital given that the hospital is fast paced and the motto is often to discharge as many as possible resulting in a lower quality of care. This can be termed as the revolving door which means that personnel between roles as legislators in the industries are affected by the legislation and regulation. However, despite this constant revolving door, I noticed a significant amount of discrimination specifically towards the ageing population as noted in this case.
Viewing this case from a social justice, advocacy point of view, I would work on a few factors in reference to Mr. Hansen’s case. It is my wishlist of interventions that weekly trainings about issues of Ageism in hospital settings can be beneficial to the team. Furthermore, a reduced amount of caseloads for SW’s may also be beneficial. Lastly, a volunteer or worker to monitor other PT’s well being.
The first thing I advocated for my client was Mr. Hansen’s Ageist attitudes from the team was confronted. The term “difficult” was initially used to describe Mr. Hansen. This terms, to me I found discriminatory and ageist as explained above. However, after I learnt that he was a holocaust survivor and relayed this to the team, the teams perception of him changed and they started to treat him differently, with more respect during their interventions with him. Labels that we place on individuals impacts the way that others perceive him or her and by team members. It is important that these individuals are informed and treated with equal dignity and respect. For instance, my intervention in relaying to the multidisciplinary team about the importance of communicating their interventions with Mr. Hansen prior to performing them would be greatly appreciated.
SW’s are often burdened with high caseloads which may increase the turnover rate causing burnout rates are high (Kim & Stoner, 2008). The systemic issue of a SW having so many cases without much time for reflection is a large issue affecting quality of care. Kim & Stoner describe how SW’s have “increasing paperwork, unmanageable caseloads, and problems with difficult clients, as well as staff shortages and reduced availability of adequate supervision” (2008, p. 6). To stress this point further, in the ICU there is one on site social worker for 28 PT’s. I view this as an issue as it may not be suffice as there could be those that fall through the cracks of the health care system. While there are those nurses that do flag high risk PT’s, however, having a volunteer specific for this job may be beneficial for advocacy of PT’s (besides for the nurses and SW’s). As a student, I am given much time to reflect on my cases and often the motto is “quality over quantity”. However, this is not realistic when it comes down to workforce it is seen more as quantity of case over quality of the case. For instance, I question myself asking that if I had a higher caseload, would I have taken the added initiative to help Mr. Hansen? Probably not. If I would have not taken the initiative to take this case upon myself, the PT may have fallen through the cracks in terms of getting quality of care prior to his death. The article allowed me to understand the PT’s needs; to remember the holocaust and never to forget. It was through my interventions that I discovered he was a Holocaust survivor in which I communicated to the team and advocated on his behalf. It is my impression that perhaps a training on the topic of “elders who have experienced trauma” may be beneficial to hospital staff for the sensitivity and respect of the PT.
Upon reflection, after having presented this case I felt relieved and that I had some closure to the case that I could discuss it and talk about it aloud. The group discussion and feedback validated my feelings of being put in a position of a grandchild. The process of putting all these pieces together was a therapeutic outlet for me and contributed to my understanding of Mr. Hansen’s needs as well as my own needs. The in class presentation and discussion allowed me to get a sense of closure to the case.
A student pointed out that the PT’s lack of social support may have contributed to my stress and felt responsibility to follow up on him every day. The fact that PT was physically alone as he did not have his wife nor children at his bedside was something that may have subconsciously made me feel an even bigger desire to offer support.
The impact on my professional development is that I am now more aware of the issues including high caseloads and burnout rates, however, I cannot say that when I will be a worker I will be different. I think that it is about having the necessary supports in order to let out one’s stress either with work colleagues or with friends, enables this professional development. Thankfully, I was lucky enough to have the necessary supervision to have helped me unpack my feelings and attitudes. Furthermore, I got the impression that the class agreed to the idea that even though I crossed some personal boundaries (answering personal questions and following up on him multiple times a day), they affirmed that my interventions were appropriate in providing positive end of life care to Mr. Hansen.
My initial reaction to this case scenario was that I felt that there was some sort of connection between Mr. Hansen and I, and that I felt that I was essentially crossing personal boundaries with him. These boundary crossings were manifested by checking up on him many times a day and answering personal questions related to remembering the Jewish history of Holocaust. Additionally, after leaving the Mr. Hansen’s room I would …show more content…
feel a sense of responsibility to retell story of the Holocaust and to learn from it.
The litterature shed light on the reasons that Mr. Hansen was so persistent on passing on the Jewish history of the Holocaust specifically the article written by Lev–Wiesel (2007). Unfortunately, I found that there is only a burgeoning amount of literature around the theme of working with elderly clients of holocaust survivors and feeling like a grandchild. Fortunately, Lev–Wiesel’s article highlights the incidence of individuals that experienced trauma and its impact across three generations indicated in her article that each member of across three generations expressed a common mission, which was “to remember the holocaust, never to forget, and to transmit this charge to coming generations” (2007, p. 83). This phrase was truly an eye opener for me as it enabled me to appreciate Mr. Hansen’s perspective by understanding the reasons that he wanted me–the third generation–to remember holocaust. At first, I felt that re-telling the Holocaust was a responsibility, and that it was something that was weighing on my shoulders. However, after much reflection, I realized that he was simply teaching me or transferring the idea to learn about the importance of this event in Jewish history and never to forget it. The literature shed light on how important it was for the holocaust survivor to tell this Jewish worker to remember the Holocaust. Similar to a grandfather that would tell their grandchild to remember the holocaust, this PT treated me as their granddaughter. This literature made me understand the reason that he was so persistent in reminding me of his Holocaust experience, the importance of never to forget it and to pass it on to future generations.
The theme of transference and countertransference can impact the counseling relationship in a positive or a negative way. Transference occurs when feelings that the client or PT have for one person are unconsciously redirected to another (Stern, Smith & Frank, 1952). Countertransference is the concept of a PT redirect feelings meant for others onto the therapist (Stern, Smith & Frank, 1952). The transference in this case, was the fact that the counselor and the PT both shared a similar social context, specifically the fact that we both identified with Judaism. The fact that we were able to bond due to sharing similar social contexts, may have facilitated the transfer of feelings regarding the importance to never forget the Holocaust and to pass it on to next generations. Stern, Smith & Frank state in their article that “in work with old people, the physician or the social worker is often considerably younger than the client and could be the client’s child is apt to modify the common situation of transference” (p. 328). As indicated by Stern, Smith & Frank, “the most common transference relationship between physician and PT is that of the "parent- child" type” (1952, p. 328). Growing up without a father in the home, it may be that I facilitated the countertransference by accepting the grandchild position and doing actions in order to make him “proud”. This need to make him proud was expressed by following up with him 3-5 times a day and answering his personal questions.
On my part, I felt that personal boundaries were crossed when working with this client, however, I felt that these boundary crossings were appropriate for the therapeutic relationship.
The fact that the PT and I shared this bonding, I felt that I crossed certain professional boundaries in doing everything in my power to make things easier during his ICU admission. I questioned myself many times asking myself “am I doing the right thing?” As I knew that checking up on the PT 3 times a day and buying a menora was not something I provided to all my PT’s. However, I felt that I was and my gut feeling told me that despite crossing these boundaries I provided the Mr. Hansen with best service before his last moments in this world. Reamer (2013) states that “a clinical social worker’s modest self-disclosure or decision to accept an invitation [...] may prove in some special circumstances to be therapeutically useful to a client” (p. 123). Alternatively, “boundary crossings are harmful when the dual relationship has negative consequences for the social worker’s client or colleague” (p. 123) And for me to have shared those final moments with him was both an honor and a learning experience. A learning experience that I took from saying that even though I did cross SW boundaries, it was appropriate because I felt that I provided him the best service he needed at that time and our social context allowed us to
bond.
Ageism is another theme present in this case, as I felt that the team was discriminatory to the needs of the PT. I met Mr. Hansen during rounds, when the ICU team was discussing the PT in front of Mr. Hansen’s room. I found the teams’ language was dismissive and disrespectful as the patient was apt (even though it may not have been so visible) and was hearing the words expressed by the team. An example of this dismissive language was that the team referred to him as “difficult” and “time consuming” and as if he was not present or listening. Ageism can be described as “regard[ing] older people as one homogeneous group rather than a range of individuals with a variety of experiences, interests, and needs, [...] can result in ageist attitudes and practices” (Duffy, 2011, p. 110). Language has a significant impact on the way one percieves the individual. The team should view elders as individuals that are wise and with lived experience. On a more critical lens however, doctors are dismissive with almost all the PT’s in the hospital given that the hospital is fast paced and the motto is often to discharge as many as possible resulting in a lower quality of care. This can be termed as the revolving door which means that personnel between roles as legislators in the industries are affected by the legislation and regulation. However, despite this constant revolving door, I noticed a significant amount of discrimination specifically towards the ageing population as noted in this case.
Viewing this case from a social justice, advocacy point of view, I would work on a few factors in reference to Mr. Hansen’s case. It is my wishlist of interventions that weekly trainings about issues of Ageism in hospital settings can be beneficial to the team. Furthermore, a reduced amount of caseloads for SW’s may also be beneficial. Lastly, a volunteer or worker to monitor other PT’s well being.
The first thing I advocated for my client was Mr. Hansen’s Ageist attitudes from the team was confronted. The term “difficult” was initially used to describe Mr. Hansen. This terms, to me I found discriminatory and ageist as explained above. However, after I learnt that he was a holocaust survivor and relayed this to the team, the teams perception of him changed and they started to treat him differently, with more respect during their interventions with him. Labels that we place on individuals impacts the way that others perceive him or her and by team members. It is important that these individuals are informed and treated with equal dignity and respect. For instance, my intervention in relaying to the multidisciplinary team about the importance of communicating their interventions with Mr. Hansen prior to performing them would be greatly appreciated.
SW’s are often burdened with high caseloads which may increase the turnover rate causing burnout rates are high (Kim & Stoner, 2008). The systemic issue of a SW having so many cases without much time for reflection is a large issue affecting quality of care. Kim & Stoner describe how SW’s have “increasing paperwork, unmanageable caseloads, and problems with difficult clients, as well as staff shortages and reduced availability of adequate supervision” (2008, p. 6). To stress this point further, in the ICU there is one on site social worker for 28 PT’s. I view this as an issue as it may not be suffice as there could be those that fall through the cracks of the health care system. While there are those nurses that do flag high risk PT’s, however, having a volunteer specific for this job may be beneficial for advocacy of PT’s (besides for the nurses and SW’s). As a student, I am given much time to reflect on my cases and often the motto is “quality over quantity”. However, this is not realistic when it comes down to workforce it is seen more as quantity of case over quality of the case. For instance, I question myself asking that if I had a higher caseload, would I have taken the added initiative to help Mr. Hansen? Probably not. If I would have not taken the initiative to take this case upon myself, the PT may have fallen through the cracks in terms of getting quality of care prior to his death. The article allowed me to understand the PT’s needs; to remember the holocaust and never to forget. It was through my interventions that I discovered he was a Holocaust survivor in which I communicated to the team and advocated on his behalf. It is my impression that perhaps a training on the topic of “elders who have experienced trauma” may be beneficial to hospital staff for the sensitivity and respect of the PT.
Upon reflection, after having presented this case I felt relieved and that I had some closure to the case that I could discuss it and talk about it aloud. The group discussion and feedback validated my feelings of being put in a position of a grandchild. The process of putting all these pieces together was a therapeutic outlet for me and contributed to my understanding of Mr. Hansen’s needs as well as my own needs. The in class presentation and discussion allowed me to get a sense of closure to the case.
A student pointed out that the PT’s lack of social support may have contributed to my stress and felt responsibility to follow up on him every day. The fact that PT was physically alone as he did not have his wife nor children at his bedside was something that may have subconsciously made me feel an even bigger desire to offer support.
The impact on my professional development is that I am now more aware of the issues including high caseloads and burnout rates, however, I cannot say that when I will be a worker I will be different. I think that it is about having the necessary supports in order to let out one’s stress either with work colleagues or with friends, enables this professional development. Thankfully, I was lucky enough to have the necessary supervision to have helped me unpack my feelings and attitudes. Furthermore, I got the impression that the class agreed to the idea that even though I crossed some personal boundaries (answering personal questions and following up on him multiple times a day), they affirmed that my interventions were appropriate in providing positive end of life care to Mr. Hansen.