Let’s talk Practically. About missing links. Through taking a step back, thinking above and behind what we clinicians do in our day-to-day work. In other words, the meta systems.

There are missing key premises behind what currently inform our theories, thereby creating a misstep in approach. We need to all look and acknowledge where the ‘cracks’ are; where we know that our ethical constraints place us at odds with what actual best practices. We want our clients to leave us better than they came to us; heading well on their way to healthy and whole. Perhaps, where we as individuals, in our private lives, need to look at where we can be doing ‘better’. How are we contributing to a less than desirable outcome, rather than working towards relational goals that help us all progress and move forward, healthy and whole?

Example: Sarah Crue is a MSW. In her practice, she had a young lady presenting with IED, depression, psychosis s/s, trauma (multiple sources over years; repeated occurrences of all: sexual, physical, abuse in all forms (emotional, physical, sexual). Polly was a 13/15-year-old (case coverage duration).Polly was self-injurious. Poor sense of limits, boundaries, social niceties/cues, with poor sensory input, perceptions. Polly presents with a limited to average ability to verbalize, have insight into, etc.

Overall, Polly had shown a willingness to progress. She worked with our support services, MDT, and court. Polly participated in extensive sessions with myself, and others in our support staff, on psycho-education with a CBT focus. Session coverage included best practice CBT trauma-based material, particularly any with tie-ins to the client’s additional diagnosis. How to identify emotions, distortions, how to connect with the unhelpful s/s Polly experiences, indenting helpful coping skills. Teaching and mentoring Polly in the integration and practice, familiarity with those coping skills and the accompanying CBT trauma theories/practices specific to Polly’s recovery.

Sarah Crue, MSW, worked with school officials; teachers were on the MDT, as well as the courts, mom, CASA, and CPS. There were educational neglect concerns. Polly was PPD with the court. CPS and Insurance had agreed to pay for Polly’s treatment. Over a year and three months, the MDT monitored the overall family as the treatment plan and time progressed. Polly’s mom, Laura, presented over time as someone who had limited insight into her daughter’s issues. Laura presents with average intelligence. Kind. Caring. With a weak emotional and behavioral responsiveness and consistent repetition of this over several years? Polly and Laura have developed an unhealthy relational dynamic characterized by Polly being permitted control of the home. Polly’s emotional responsiveness created turbulence amongst the household, which was comprised of a boyfriend, grandmother/father presence, plus two other sibling type figures in this case.

Polly requisitioned an unhealthy majority portion of the families available time, money, and emotional, financial, actual interaction, etc. This created resentments and relational stressors amongst family members and with Polly. Polly had control of Mom’s money even credit cards. Polly threw fits/tantrums, utilizing self-harm threats and actions to achieve her desired outcome. Polly used, screaming, emotional guilt games, threats, and blackmail to maintain control over the mom.

At the end of Sarah involvement in this case, Polly and Laura’s relationship showed signs of improvement. Laura began to take some time for self-care, which resulted in lower stress levels, increased use of coping, decrease in conflict incidents between Laura to Polly, and other family members. Polly began to respond to conflict better, using coping skills to break the cycle of self-injury. Polly went to school more. The use of behavioral skills with Polly and support staff, created an awareness of the positives found in that dynamic in a relationship of that nature. Polly found some respect for that, saw and experienced the benefits of that, and enjoyed that experience. It informed Polly’s behavior moving forward, thus paving the way towards more positive authority interactions and peers, parents, etc. Polly’s incidents of self-harm decreased.

The family was educated on the benefits/importance of a commitment to consistent boundaries/responses. A lack in that area is a primary deficit in the parent/child interaction in this population and in regards to the issues inherent. Our common experience as social work practitioners? Consistently shows that even post-intervention by our combined teams and systems? Is that there continue to be major deficits in this area, that continue to contribute to repeat/worsen individual and family/social/system issues.

Polly and Laura, plus family, where not cured. Better, moved forward with a knowledge and introduction to the benefits gained from supports and services provided through the case. And yet. We can see this is a less than desired outcome, still far from what we may have hoped for. Here is a missing piece in our meta-debate; This is part of what needs to be brought out, examined, and corrected. Let’s begin!

This is a story we can all respond to. A (too) common element(s); school abscesses, behavioral issues, family issues, and finally, the (consequent) legal and society(al) issues. We, as professionals in the field, community members, parents, children, must stop and take stock. Assess, and then address these areas. Discuss them, share your thoughts here.

What are some possible solutions? How can we; as practitioners, as community members. Family to our loved ones. Friends and neighbors. What can we do to create a better tomorrow for one another?