Question 1

Sally’s family is a household with only one parent –her mother, SM. She works to support Sally and her sister, Sam, who is an eighth grader. The children’s father works out of the New York state. However, he visits his once or twice a month. Because SM works during the daytime, Sally is taken care of by her grandmother, SGM. The family was originally from Fujian, China. At home, they speak Fuzhouness, which is a Chinese dialect. Therefore, Sally’s primary caregiver, SGM, does not speak Mandarin. Since only SM could communicate with me in basic Mandarina, home visits were conducted when SM got off work.

When I first established contact with Sally’s family in fall 2018, she had difficulties transitioning from one activity to another and expressed her frustration in a terrible temper tantrum. The family would try to distract Sally from her vexation by tempting her with ice cream or candy, which reinforced the toddler’s meltdown. After discussing with the family, we worked on this issue for three months and made progress. To date, Sally has been able to follow a simple daily routine without much struggle. Additionally, she can calm herself down when she gets upset.

Despite the successful collaboration, the family has a distant relationship with me. SM, in particular, is naturally secretive. Therefore, she avoids disclosing personal information as much as possible. However,  two months ago, she told me that she was diagnosed with breast cancer and was receiving surgery and chemotherapy. I was explicitly astonished when Sally requested my help to find a cheaper place to live. Moreover, I discovered that the family was experiencing financial hardships since SM could not work due to her illness. Their most significant financial burden was rent. Thus, I had a new task; to work with the family to help them explore housing options.

Nevertheless, solving housing problems is not a common goal of Early Head Start (EHS). The organization, which is my internship agency, provides children below age three as well their families with comprehensive services to support early child development. EHS’s clients receive bi-weekly home visits and case management provided by family child specialists like me. Additionally, the firm offers part-time, center-based child care programs to its customers. In that regard, family child experts set child-focused goals to address developmental issues and promote early childhood development directly. On the other hand, various family-focused objectives are created to enhance a stable and nurturing family environment for children.

Question 2

Two layers of crises occur in the family. These issues include emotional distress and financial challenges. However, SM was avoidant to talk about her emotions or how the family was handling it. Instead, her coping mechanism focused on solving practical difficulties. She was determined to use her cancer problem to benefit her family optimally. For example, the patient asked her doctor to write up a report concerning her condition. She planned to use the document for social welfare applications. Unfortunately, we found few social welfares for cancer patients in New York although this kept her mind occupied. SM’s strength is that she was fighting in her best effort to prevent the disease from tearing her down. I think she was trying to find a silver lining in her cancer and to focus her mind on it. The patient hoped that the condition could bring her better social welfare recourses.

In my opinion, SM wanted to cope as she did for various reasons. First, emphasizing on practical matters is a typical coping method in Chinese culture because people are not comfortable talking about negative experiences (Chan & O’Connor, 2008). Notably, many Chinese families do not believe in discussing sad feelings because talking about miseries does not solve it. Instead, individuals should sublimate their gloomy experiences into actions that can practically alleviate their suffering. Moreover, some Chinese believe that it is impolite to ventilate personal miseries since everyone has their own difficulties.

Secondly, Sally’s family has exclusive dynamicity. For example, SM was incredibly protective of her family members from non-members. Maybe she had her emotional support at home, and therefore, chose to use me only as a source of practical help. Nevertheless, I decided to respect her privacy and to assist her according to her expectations.

I mainly supported SM and her family in two ways. First, I offered practical resources upon SM’s request. I researched and provided housing as well as cancer-related social support resources. For instance, we worked on public housing application together. On the other hand, I conveyed my moral support by respecting her privacy while consistently supporting on her practical matters. For example, when SM’s condition stabilized this week, she called and disclosed her progress to me. By engaging me, SM implied that she felt my participation in her fight against cancer even though I hardly expressed my support to her in words. Furthermore, the effective aid I offered helped Sally’s family by alleviating the care giver’s mental distress. Therefore, my goal reflects EHS’s mission of children by supporting their caregiver and their family environment.

Question 3

EHS delivers comprehensive services to promote zero-to-three child development. For this reason, I have the opportunity to cooperate with Sally’s family for three years. Although I have worked with the family for nine months, my service is in a long-term timeframe. Under this timespan, a short-term goal is necessary every three to four months. While the long-term objective is to build a trusting relationship with the family, all the short-term goals will be achieved based on the relation. In the case of SM’s family, the short-term objective for fall 2018 was to facilitate Sally’s transitions process. However, Sally’s family member encountered a sudden disease in spring of 2019. Thus, before setting up my new objectives, I assessed the need for crisis intervention to assist the patient. Once the family was better positioned to fight the disease, we defined a short-term task to support the family. Because the family is practical, both short-term interventions are solution-focused.

As Goldstein & Noonan (1999) state, short-term treatment can effectively address urgent needs while clients receiving a long-term treatment can benefit through personal growth as well as improved self-awareness. This statement coincides with Sally’s family in the EHS program. In particular, the family’s immediate needs were met by short-term goal setting. At the same time, in the long-term timeframe, Sally’s mother grew in terms of self-awareness. The short-term goals must be approved by both the family and the family child specialist. However, short-term treatment does not address the problems not acknowledged by the family.

Further, as Hepworth & Larsen (2017) points out that a solution-focused intervention ignores the relationship between a client and a social worker. Nonetheless, the long-term timeframe counters drawbacks of the short-term goals. Moreover, the long-range interactions between a family and a home visitor can help  caregivers become more observant and reflective. By contrast, without the short-term goal setting, home visits can be nothing more than aimless chatting and playing.

Question 4

As demonstrated in the following excerpt, I attempted but failed my check-in with SM. I often ask an open-ended check-in question, and many families take it as an invitation to ventilate. However, SM avoided my question that addressed her wellness.  On the one hand, I thought she did not want to discuss with me about her struggles. For one, “wellness” is a difficult topic for most people, especially traditional Chinese woman. Therefore, SM probably felt ashamed of talking about her disease even though she secretly wanted to.

Nevertheless, I should have followed up my check-in question by using the technique from motivational interviews to reassure SM that I can be a safe space for her. Brodsky & Lichtenstein suggest that to reluctant clients, a therapist can use statement instead of questions (1999). Therefore, I should have followed up the answer by saying “I am happy you are taking such good care of Sally, but I was also concerned about your wellbeing. I don’t mean to pry, but I want you to choose your comfort level to share. I know some people believe venting about feelings is not polite. But at times, venting out can be helpful. I want you to know that I am a safe space and I aim to support you in whatever you need.”

In the following excerpt, I engaged SM in task-focused strategies. The purpose of the task is to explore public housing options, and according to Hepworth & Larsen (2017), I motivated the client.  I was about to start step two, which is about planning the details of carrying out the task. In retrospect, I overestimated SM’s commitment to collaborate for the activity; she seemed to be exceptionally keen. I did not realize SM perceived me as the problem-solver and expected me to “find a house for her.” I should have involved her in the researching process. Moreover, before performing the task, I should have doubled my efforts to strengthen her commitment.

Further, Sally’s family has been in the public housing waitlist for ten years. However, the reason they have not got any housing arrangement is that they failed to renew their waitlist status for a couple of times due to SM’s opposing view of the system. Therefore, I brought the information on HPD to challenge her beliefs. This is an intervention of cognitive reconstruction.

Question 5

As Yan & Wong (2005) point out, cultural competence should incorporate self-awareness because only when a social worker analyzes her own cultural identity can he/she recognize the cultural value and beliefs they contributed to the working relationship. By reflecting on my cultural background, I realized that Sally’s family and I are culturally different even though we both Chinese.

I grew up in the Northern city where a collectivist culture is deeply rooted. People are close to each other in their community and hospitality to guests is a standard feature. Sally’s family, on the other hand, is from a southern Hakka cultural origin where individuals tend to be exclusive and private. Moreover, in addition to the geographic differences, my education experience transformed my Chinese culture. Notably, Sally’s family mainly holds on traditional Chinese values. Besides, I suspect SM came to the states illegally and went through some tough time before she finally settled down. Further, as an F1 visa holder, I had a different experience in the states. As Atwood & Conway (2004) concludes, there are many individual cultural differences among Chinese American values. Therefore, it is critical for me to approach each family with cultural humidity to learn about the dynamic of our differences.

As a result, Sally’s family was reserved when we were establishing a relationship. SM talked as little as possible and avoided most of my interview questions. Furthermore, the family members liked communicating in their local dialect in presence. For this reason, I felt like I was an invisible intruder, although my first reaction did not reflect the cultural differences. In particular, I never took the rejection personal even though I was pushed away and my fear of abandonment as the countertransference evoked. I have a misbelief that when people reject me in a relationship, it means I am not good enough. Under the influence of countertransference, I was afraid of engaging SM when she appeared avoidant. I deemed her avoidance as her dislike towards me, and I feared that if I pushed her, she would have disliked me more.

References

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Atwood, J.D. & Conway, B.Y. M. (2004). Therapy with Chinese American families: A social

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Brodsky, S., & Lichtenstein, B. (1999). Don’t ask questions: A psychotherapeutic strategy for treatment of involuntary clients. American Journal of Psychotherapy, 5(2), 215-220.

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Goldstein, E. & Noonan, M. (1999).  Short-term treatment and social work practice: An integrative perspective.  NY: Free Press.  Chapter 1 (pp. 3-34).

Hepworth, D.H., Rooney, R. & Larsen, J.A. (2017). In Direct social work practice: Theory and skills (10th ed.). Pacific Grove, CA: Brooks/Cole. Chapter 13 (pp. 385-

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