Why NASW Standard 1.01 Commitment to Clients may pose a challenge?

Jake Levy (31) and Sheri Levy (28) are a married Caucasian couple who live with their sons, Myles (10) and Levi (8), in a two-bedroom condominium in a middle-class neighborhood. Jake is an Iraq War veteran and employed as a human resources assistant for the military, and Sheri is a special education teacher in a local elementary school. Overall, Jake is physically fit, but an injury he sustained in combat sometimes limits his ability to use his left hand. Sheri is in good physical condition and has recently found out that she is pregnant with their third child. As teenagers, Jake and Sheri used marijuana and drank. Neither uses marijuana now but they still drink. Sheri drinks socially and has one or two drinks over the weekend. Jake reports he has four to five drinks in the evenings during the week and eight to ten drinks on Saturdays and Sundays. Neither report having criminal histories. Jake and Sheri identify as Jewish and attend a local synagogue on major holidays. Jake's parents are deceased, and he has a sister who lives outside London. He and his sister are not very close but do talk twice a year. Sheri is an only child, and her mother lives in the area but offers little support. Her mother never approved of Sheri marrying Jake and thinks Sheri needs to deal with their problems on her own. The couple has some friends, but due to Jake's recent behaviors, they have slowly isolated themselves. Intake and Assessment The social worker's first encounter with Jake was at an intake session at the Veterans Affairs Health Care Center (VA). During this meeting, Jake stated that he came to the VA for services because his wife had threatened to leave him if he did not get help. She was particularly concerned about his drinking and lack of involvement in his sons' lives. She told him his drinking had gotten out of control and was making him mean and distant. Jake had seen Dr. Zoe, a psychiatrist at the VA, who diagnosed him with posttraumatic stress disorder (PTSD). Dr. Zoe prescribed Paxil to help reduce his symptoms of anxiety and depression and suggested that he also begin counseling. During the assessment, Jake said that since his return to civilian life 10 months ago he had experienced difficulty sleeping, heart palpitations, and moodiness. He told the social worker that he and his wife had been fighting a lot and that he drank to take the edge off and to help him sleep. Jake admitted to drinking heavily nearly every day. He reported that he was not engaged with his sons at all and he kept to himself when he was at home. He spent his evenings on the couch drinking beer and watching TV or playing video games. When Jake's options for treatment were discussed, he expressed fear of losing his job and his family if he did not get help. Jake worked in an office with civilians and military personnel and mostly got along with people in the office. Jake tended to keep to himself and said he sometimes felt pressured to be more 2 2022 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Sessions: Case histories. Laureate International Universities Publishing. communicative and social. He was also very worried that Sheri would leave him. He said he had never seen her so angry before and saw she was at her limit with him and his behaviors. Based on the information Jake provided about his diagnosis and family concerns, he and the social worker agreed that the best course of action would be for him to participate in weekly individual sessions and a weekly support group that was offered at the VA for Iraq veterans. The social worker then offered a referral for couples counseling at the local mental health agency. The social worker also printed out a list of Alcoholics Anonymous (AA) meetings in his area if he decided he wanted to attend in order to address his drinking. He would continue to follow up with Dr. Zoe on a monthly basis to monitor the effectiveness of his medications. Sessions During the following session, the social worker spent time explaining his diagnosis and the symptoms related to PTSD. Jake said that he did not really understand what PTSD was but thought it meant that a person was "going crazy," which at times he thought was happening to him. He expressed concern that he would never feel "normal" again and said that when he drank alcohol, his symptoms and the intensity of his emotions eased. The social worker explained to Jake that PTSD is a severe anxiety disorder that develops after a person has experienced an event that results in psychological trauma. The event may involve the threat or perceived threat of death to oneself or to someone else. The social worker also explained that the disorder is characterized by reexperiencing the traumatic event, including the symptoms of increased arousal, and by the desire to avoid stimuli associated with the trauma. They discussed how Jake's behaviors fit into this cycle of hyperarousal and avoidance, including his lack of sleep and irritability and the isolation and heavy drinking. He talked about always feeling "ready to go." He said he was exhausted from being alert and looking for potential problems around him. He told me he always felt on edge, and every sound seemed to startle him. He shared that he often thinks about what happened "over there" but tries to push it out of his mind. It is the night that is the worst as he has terrible recurring nightmares of one particular event. He said he wakes up shaking and sweating most nights. He then said drinking was the one thing that seemed to give him a little relief. The social worker gave him a handout on PTSD and reviewed the signs and symptoms. Jake seemed relieved to receive the information. The social worker conveyed that naming the issue or concern was often helpful in the healing process. During the first few sessions, the goal was to help Jake feel safe and validate his feelings. As such, the social worker consistently assessed his feelings of safety, including any potential suicidal ideation. Jake was reluctant to attend AA at that time, so he and the social worker began monitoring his drinking and his behaviors after several drinks