Maria is a new PsyR worker just learning "the ropes." As you read about what happens to Maria and the consumer she is working with, think about how the situation might have been avoided. Also, consider who was really responsible for the problem. (Hint: There was more than one way to avoid this problem and more than one person responsible.)
Maria always knew that she wanted to work with people. During high school she volunteered at a geriatric home on weekends, reading to some of the residents or helping them with activities such as shopping for personal items or just keeping them company. She majored in psychology at the small Midwestern college she attended. Most of the courses she took covered basic psychological theory, research methods, and statistics. Her dream was, someday, to get her Ph.D. and do private therapy. During college she volunteered at a private psychiatric hospital working with the activity therapist. She liked working with the patients. Maria could relate well because many of the patients were her age. She found it very interesting to talk with them about their symptoms.
During her senior year, she applied to several doctoral programs in clinical psychology. One of her psychology professors told her that it was harder to get into a clinical psychology program than to get into medical school. She wasn't even contacted for an interview. After graduation Maria went home and searched for a job where she could use her psychology degree. After looking all summer she ended up working as a clerk in a local bookstore. One day a friend of her mother told Maria about a program for people with severe mental illnesses that was looking for people with B.A. degrees to provide services. Maria applied, and on the strength of her previous experience and education, she got her first psychiatric rehabilitation job. She was really excited.
After a week-long orientation to the program she was assigned to work with Mark. Mark had a master's degree in rehabilitation counseling and more than 4 years of experience working in the program. Mark and Maria were responsible for a caseload of 11 clients. Maria quickly got to know the clients and the tasks she had to perform as a case manager. After only a few months, she and Mark decided that she would be the primary case manager for John and Helen, two clients with whom she had developed a close relationship. Maria felt that she was really starting to grow as a professional.
When it came to her role as case manager, Maria made sure that she covered all the bases. She genuinely liked John and Helen and she also wanted to prove to Mark that she could do a good job. She reviewed their treatment plans with them and established regular goals for them to achieve. Best of all, they were achieving these goals, and sometimes faster than scheduled. One day Helen was absent on a day when she had an important meeting. That afternoon, Maria called her boarding home, but they said Helen was out; they thought she had gone to the program. The next day Helen was absent again. Maria called the boarding home right away and they said that she had left that morning at her regularly scheduled time; they assumed she had gone to the program. Maria became very worried and went to tell Mark what was happening. The police brought in Helen that afternoon. They had found her acting strangely in the park and when they had asked if she needed any help she had started screaming and run away. Helen was hospitalized that evening.
When Helen returned to the program, Maria asked her what had happened. Why had she stopped going to the program when she was doing so well? Helen said she knew that she was making real progress with Maria's help. One day she began hearing voices and she became unable to sleep at night. She remembered that Maria had said that if she took her medication and worked on her treatment plan she would get better, but at the same time she knew she was getting sick. She knew how much effort Maria put into helping her and what a caring person she was. She felt like she was letting Maria down. Maybe Maria would be very disappointed in her or even very angry. When she got too sick to control her symptoms, she would go to the park rather than let Maria see her that way after all the work she had done.
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