Pomeroy, E., & Garcia, R. (2009). Case 8.1. In The grief assessment and intervention workbook: A strengths perspective (pp. 227-229). Cengage Learning.
Sub Topics
Identifying Information
Client Name: Veronica Maldonado
Age: 24 years old
Ethnicity: Hispanic
Educational Level: Master’s degree
Occupation: Social worker
Background Information
Veronica began working full-time in the bereavement department at a hospice 9 months ago. Her primary job duty is to provide counseling to the families of the hospice’s patients, in addition to bereaved persons in the wider community. She also leads a support group for people who have lost their mothers. The following is Veronica’s first session with Anita Davenport, a therapist with over 15 years of experience.
Initial Interview
| ANITA: | Tell me what brings you here, Veronica. |
| VERONICA: | I feel so stressed out all the time! I feel like I’m cracking up! I just can’t seem to keep it all together. |
| ANITA: | Tell me what is stressing you out? |
| VERONICA: | I don’t know, exactly. That’s part of the problem. It just seems to be this permanent state I’m in. I’m either really tense or completely exhausted or both. |
| ANITA: | Tell me more about what you feel when you are stressed out? Are you anxious, afraid, sad, angry...?” |
| VERONICA: | It’s anxiety, I guess. And I’m more irritable than I normally am. I seem to get frustrated very easily. |
| ANITA: | What are some things that frustrate you? |
| VERONICA: | Well, last weekend my boyfriend went out of town. He was supposed to be back by 2 p.m. on Sunday. Well, 2 o’clock came and went and I didn’t hear from him. I kept trying to call him on his cell phone but he was out of range. He didn’t get in until 2 hours later. I absolutely flipped out. I told him that if he was going to be late, he needed to call me and let me know! |
| ANITA: | What specifically about your boy-friend being late and not calling you upset you? |
| VERONICA: | I was worried. What if some-thing had happened to him? I kept having visions of him lying dead on the highway! |
| ANITA: | I see. What are some other examples of times that you have felt frustrated or anxious? |
| VERONICA: | Let’s see.... Well, there is always work. I can’t seem to get all my documentation done and I always have a list of clients that I need to call. By the time I get home, I’m completely wiped out. I practically fall into bed but then I can’t get to sleep! |
| ANITA: | What’s happening that you can’t sleep? |
| VERONICA: | I just can’t turn my mind off. |
| ANITA: | What are you thinking about? |
| VERONICA: | Work, usually—like all the stuff I need to do the next day. And my clients. |
| ANITA: | What kinds of thought do you have about your clients? |
| VERONICA: | I find myself playing the sessions over again in my head and thinking about what I said and what I might say in our next session. And sometimes I’m just imagining the stories they have told me. Actually, that is probably why I flipped out on my boyfriend. You see, I have a client right now who was in a car accident with her husband. She survived, but he died at the scene. It’s been real traumatic for her and she has really come to depend on me to help her through it. |
| ANITA: | So, your reaction to your boyfriend being late was really a reaction to hearing such a traumatic story from your client. |
| VERONICA: | Yeah, I guess so. I hadn’t realized that until just now. |
| ANITA: | It sounds like you are working during the day and at night! It’s no wonder you are exhausted! And hearing intimate details of such sad and traumatic stories will certainly take a toll on you. Do you think that could be the source of your stress? |
| VERONICA: | You are probably right. I do seem to carry all of my clients’ stories around with me. I find that I think about them all the time. |
| ANITA: | How does that feel for you? |
| VERONICA: | It drains me. And it kind of creeps me out thinking about how such tragic things happen to people every day and that it can happen to anyone at any time. I think it’s been making me worry about my mom more lately. I see these people in my Loss of Mother group just agonizing over their mother’s death. I imagine what that would be like for me and it’s just awful. I would be a mess if I lost her! Sometimes I feel like I’m just waiting for my mom to die—not that I want her to—but I know that she will someday. When you do this kind of work you are constantly reminded of that. I’ve even had nightmares about it. |
| ANITA: | I see that you are getting a little teary as you talk about this. |
| VERONICA: | Yes, I guess I haven’t realized the kind of impact my work has been having on me. |
| ANITA: | It sounds like we need to help you find ways to take care of yourself while you are doing this kind of work. Tell me, what is your caseload like? How many clients are you seeing? |
| VERONICA: | I see about 30 or so people per week and facilitate the support group. |
| ANITA: | My goodness! That’s a full load! What is your schedule like? Is it a 9 to 5 schedule? |
| VERONICA: | My schedule is different every week. It varies depending on when the clients can meet with me. Sometimes I have a lot of morning appointments and sometimes I see more people in the evenings. And then some days I see clients in the morning and in the evening with some time in between. I usually use that time to catch up on my documentation, though. |
| ANITA: | You know, Veronica. If I had a work situation like yours, I think I would feel very stressed out. Not only are you working around the clock in some fashion or another but you have a high caseload, some very tough and painful client situations, and it doesn’t sound like you really have any time for yourself! Am I right? Do you feel like you have a life outside of your work? |
| VERONICA: | No. You’re right. Work is my life. And actually, my boyfriend snapped at me the other day and said, “Can we please talk about something besides your job?” |
| ANITA: | So, work seems to be taking over your personal life and is even interfering in your relationship. |
| VERONICA: | Yeah, I guess it is. But what am I supposed to do? My clients are vulnerable and in tremendous pain. They need me. How am I supposed to just cut them off? |
| ANITA: | If you are working with bereaved persons you are certainly working with people who are in a great deal of pain and, yes, your clients are at a vulnerable place in their lives right now. Your dedication to your clients is outstanding, Veronica. But I’m concerned about how long you can keep this up and how effective you can be with your clients when you are so stressed out that you have become a client yourself. |
| VERONICA: | I guess I thought I was just doing my job and being a dedicated social worker. |
| ANITA: | All of that is true, but perhaps you have some unrealistic expectations about what your clients expect from you and what is realistic to expect from yourself. Very often when people are in a vulnerable, needy place, they will take everything you offer them. Our goal with clients, however, is not to create a dependence on us but to help them know how to help themselves. Does that make sense to you? |
| VERONICA: | I think so. |
| ANITA: | Also, Veronica, remember that being a counselor does not make you superhuman. In fact, it’s your humanity and your superb ability to have empathy for other people that makes your work so intense and personal for you. |
| VERONICA: | I think I understand what you mean. |
| ANITA: | And as you well know Veronica, your relationship with your clients is everything. It’s the foundation upon which you are able to be productive in your work with them. A healthy and productive client-therapist relationship begins with a healthy therapist. In other words, I am concerned not only about how all of this is affecting you but how it is affecting your clients. |
| VERONICA: | Wow. I had never really looked at it that way. |
| ANITA: | I am sure you tell your clients about the importance of self-care. |
| VERONICA: | Yes, all the time. |
| ANITA: | Are you practicing what you preach? Are you taking care of yourself? |
| VERONICA: | Not really. I guess I figured that it didn’t apply to me because I’m a counselor. |
Anita and Veronica continued to talk about ways that Veronica could set boundaries at her work and implement a practice of self-care. Veronica schedules another appoint-tment with Anita for the following week.
Reflection questions
- Do you think Veronica is experiencing compassion fatigue? Identify the symptoms that support your answer.
- List five work habits or thought patterns that could lead to compassion fatigue.
- What resources could Veronica access to help her manage the stress of her work?
- How might Veronica use her therapy with Anita to help her cope with the work stresses in life-enhancing ways?
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