Briefly describe the case you have chosen. Categorize the social worker’s experience as vicarious trauma, compassion fatigue, or burnout. Provide justification. Identify the s

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TRANSCRIPT – Case Studies

Overview of the Organization

Berkshire Community Health (BCH) is a comprehensive healthcare facility serving western Massachusetts. BCH’s central campus consists of emergency services; specialty medical units, including a leading oncology department; a behavioral health therapy unit; and a social work team. Social workers are integrated throughout the facility to support behavioral health and interdisciplinary care. The social work team is supervised by Janell Morris, who is empathetic and supportive. Janell communicates effectively and encourages team-building through regular check-in meetings. The team is close and compassionate with one another. However, social workers often experience conflict with other collegial relationships beyond the team. As they are embedded within various units in the facility, they must work in interprofessional collaboration with other disciplines. Overall, social workers are devalued outside of the social work team. Recently, BCH rolled out a public relations campaign in which they declared the organization to be “trauma-informed.” However, no organization-wide policies or procedures have been implemented that reflect trauma-informed principles, nor were social workers consulted in the development of the campaign. To support the health and wellness of staff, the organization has an employee assistance program that is available 24 hours a day, 7 days a week. The organization also offers premier health insurance for full-time employees. Full-time constitutes working at least 36 hours a week.

Social Worker 1: Tyrone Tyrone is a 41-year-old male social worker who identifies as heterosexual, Black, and Latino. He is a divorced dad to a teenage daughter and shares custody with his ex-wife. Tyrone conducts individual therapy with clients at BCH to address mental health and substance use. In his therapeutic role, Tyrone sees individuals with complex trauma who have high therapeutic needs, compounded by high case-management needs. The expectation for this role is to see seven or eight clients per day, a standard that Tyrone has kept up with throughout his employment over the past 4 years. Substance Use and Work Tyrone, who has no recent history of substance use, has started drinking one to three glasses of wine at night and “nips” of alcohol during the workday. Tyrone explains that he “feels emotionally numb” and has difficulty concentrating and completing tasks at home and at work. He has begun to avoid people, places, and things that remind him of

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work with his clients, and he has also canceled sessions with clients who have higher levels of trauma to “stop my heart from pounding.” Tyrone complains of decreased sleep due to nightmares, difficulty falling asleep, and experiencing anxiety, but reports that he can “handle it on my own” by “doing what I need to do.” He has also expressed that he doesn’t know why he continues to meet with clients because “I’m not going to help them in the end anyway.” Social Support and Self-Care Tyrone describes limited social support. He declined invitations to social events for months, and, when he did attend, he’d just frustrate his friends by talking mostly about work. He also started expressing the belief that something bad is going to happen and that there is little hope for anything to change in the future. When friends attempted to confront Tyrone about their concerns, Tyrone became angry and irritable. Tyrone stopped attending church 3 months ago because he was “too tired” to go. He had previously identified church as a primary support. Tyrone reports a positive relationship with his ex-wife. He also reports a good relationship with his parents, who live a couple hours away. For self-care, Tyrone attempts to journal 3 or 4 days a week and takes short walks with his dog in the morning and evening. Anxiety Tyrone describes a recent event in which his 16-year-old daughter came home several minutes late from a social event. He began thinking of a client he was working with whose child had been murdered. Tyrone was pacing, looking out the window, and texting his daughter repeatedly because he became extremely anxious about her whereabouts.

Social Worker 2: Mei Mei is a 25-year-old female social worker who identifies as heterosexual and Asian American. She lives with her mother 1 hour away from BHC but is planning to move into her own apartment in an area more convenient to work. In her role at BHC, Mei is an emergency room social worker who performs psychological assessments and manages crises. Mei recently had an annual physical with her primary care physician, during which she complained of gastrointestinal (GI) upset. The primary care physician confirmed GI upset as well as high blood pressure and weight gain due to binge eating. The physician has referred Mei to you for therapy. Work Mei explains that work has become difficult for her, especially the unpredictability of the days in the ER. She is expected to work four 10-hour shifts a week and is also expected to take additional shifts as needed, due to a high rate of staffing turnover. Mei finds it

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difficult to separate personal and professional life as a helper, often thinking about her cases on the commute to and from work. On one morning’s commute, a car veered into her lane, and she was slow to react. She regretted that it did not result in an accident because then she “wouldn’t have had to go to work.” Mei reports feeling trapped by her job and that the work no longer satisfies her. She had thought she was doing what she wanted, but is now feeling like she made a mistake in choosing this line of work. Despite feelings of avoidance, Mei has difficulty setting boundaries with work and often stays for 12–14 hours. She feels as though the job is never finished. Her behavior is reinforced by colleagues in the ER telling the team to be “like Mei.” Physical Health Mei’s physical health has declined over the past year. She has gained 50 pounds because she often eats fast food, as it is “easier and more satisfying.” When Mei returns home after work, she eats several snacks and watches dramas on a streaming video service and “zones out.” She does not feel that she has the energy to exercise. Social Support and Self-Care In this same timeframe, Mei has felt herself losing a sense of connectedness to others, both personally and professionally. She has two childhood best friends who hold her accountable and are expressing concerns. However, she has reduced her time engaging socially with her friends and with her younger cousins, who are like siblings to her. In the early mornings at work, Mei feels particularly bad in her stomach and has been avoiding completing assessments in the ER at that time. Mei continues to engage in faith-based practices and has a good relationship with her mother, even though her mother is often already asleep when Mei returns home from work.

Social Worker 3: Destiny Destiny is a 52-year-old female social worker who identifies as queer and White. She lives with her partner, Candace. At BHC, Destiny serves as a case manager on the specialized oncology interdisciplinary team. Destiny and Candace have been fighting, with Candace reporting that Destiny’s mood is unpredictable and that she gets upset “over the littlest things all the time.” In a recent argument that became particularly hostile, Candace broached the subject. “Hey, I’ve noticed that you are more irritable lately…. What can we do differently?” Destiny denied being irritable. She yelled and threw her phone, and then said, “All you ever do is point out what I do wrong! What about what you’re doing?” Following the argument, Candace urged Destiny to see a therapist.

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Mood Destiny and Candace have been fighting, with Candace reporting that Destiny’s mood is unpredictable and that she gets upset “over the littlest things all the time.” In a recent argument that became particularly hostile, Candace broached the subject. “Hey, I’ve noticed that you are more irritable lately…. What can we do differently?” Destiny denied being irritable. She yelled and threw her phone, and then said, “All you ever do is point out what I do wrong! What about what you’re doing?” Following the argument, Candace urged Destiny to see a therapist. Work Destiny reports that she has been calling out from work on a regular basis. She is enraged by the policies of the organization that require taking on additional shifts due to staffing turnover. Additionally, Destiny had a recent conflict with colleagues in oncology regarding how they treat her and “talk down to her” as the social worker on the team. She made an initial angry comment, but now feels it is “pointless” to try and find a resolution because “it won’t make a difference.” Destiny states that day after day, she sees suffering and pain, and for the past 10 years she’s seen more people die than in all the previous years of her life. Social Media Use Destiny’s partner, friends, and colleagues have all commented on the excessive use of social media. Candace states that Destiny feels the phone is more important and only wants to connect with people who “are social media friends.” Coinciding with the increased use of social media, Destiny has started to withdraw from her partner. When she does communicate with Candace, the communication is filled with anger, yelling, and frustration. Destiny displays limited insight into why she might be irritable or avoidant. Social Support and Self-Care Destiny draws on the supportive relationships with her parents and in-laws and the bond she has with her supervisor, Janell, as they have worked together for 10 years. In the past, Destiny has enjoyed hiking and reading mystery novels. She also loves playing with her cat.