OBSERVATION & ASSESSMENT, 1st REPORT

Client: A.Z., MSW 

TIME SUMMARY

I observed A.Z. interact with three clients, face to face; I also observed a number of phone calls, one with a client, others that came in from EMPLOYER partners, and some that A.Z. placed. I also talked with A.Z. and his EMPLOYER counselor as well as with A.Z. and one of his peers.  I have exchanged a number of emails with A.Z. and spoken to him by phone several times. When I spoke with his supervisor, A.Z. was not present. 

In total, from the beginning of our initial contact, I have spent almost 10 hours either observing or communicating with A.Z.

GOAL

 My goal, which I have stated to everyone involved, is to help A.Z. gain skills and confidence so that he is in a position either to stay in his present employment or freely chose to leave. As A.Z.’s advocate, I am committed to seeing that he can make choices based on what he understands about his own strengths and basic temperament. 

OBSERVATIONS AND ASSESSMENT

 A.Z. is a driven, intelligent, motivated man with strong ideas of how things ought to work. He was friendly and welcoming in the interactions I observed. He is encouraging with consumers and allows them to lay out their story, but kindly herds them back to the point, which is the next step in the overall EMPLOYER process. 

The EMPLOYER consumer population presents a variety of challenges. A.Z. appears fine with the ambiguity of the population, as a general theoretical concept. Under most circumstances, I suspect he is comfortable with the ambiguity inherent in each individual consumer.

We had the opportunity to touch base about a client with whom he had telephone contact. I recognized the person’s voice and remarked that I had lived in the same neighborhood with this person for over a decade.

I said something along the lines that it must be frustrating to deal with someone who appeared to spend his life in a near miss with responsibility and accountability.

A.Z. was matter of fact about that aspect of his job. Some people will be placed successfully, and others won’t.  We discussed when and how cases get closed.  He spoke with professional certainty about making these decisions.  And he told the door was always open if consumers made another contact asking for assistance.

I see A.Z. as having a series of boxes in his head, each with reference materials for particular situations. He doesn’t so much draw out the contents of the box, but crawls into them. His professional box clearly has a great deal of material and he is able to offer a great deal as a social worker, as long as he feels safe.

I am not in a position to probe deeply into A.Z.’s psyche. But even if A.Z. has issues that more appropriately could be addressed by therapy, I think he has the mental and emotional capacity to learn a number of skills via the coaching process

 Obviously, A.Z. wouldn’t be where he is without a great deal of tenacity and resourcefulness. Because of this mental strength, he is his own worst enemy when it comes to developing a compassionate and accepting attitude toward himself.

In other words, the strengths that have brought A.Z. to this point in his life have become a liability unless he learns to let go, becomes accepting of things as they are, and moves out of his head to get more comfortable letting his heart call some shots.

 One obvious challenge for those around him is that A.Z. frequently presents a picture of uncertainty.  It isn’t always clear where he plans to move next.  He sends contradictory messages: on one hand he can move and do things in a deliberate, direct manner – as if he were sighted; on the other hand, he hesitates when he is close to some who is standing and beginning to move, as if he is trying to decide where he needs to move, or what to do next.

Although the issue of A.Z. being unskilled at reading other people was brought up, I wonder if often it is A.Z.’s hesitant signals that create confusion?  Without drifting too far into deep personal motivations, I would be interested in having A.Z. consider whether it would be best to clearly indicate to consumers that he is visually-impaired. He didn’t use his cane at EMPLOYER at any point that I observed him. I did not bring this up, but it will be a point for us to examine as we try to clarify A.Z.’s signals to consumers and his fellow employees at EMPLOYER.

The issue of A.Z.’s insecurity came up in our talk with Katy.  She brought up her initial impression of him as being very insecure. This creates major cognitive dissonance for both consumers and peers.

A.Z.’s self-talk contributes to his over all stress level. He tends toward all-or-nothing thinking.  He apparently can suspend this approach with consumers that are reasonably compliant.  Although I didn’t witness any interactions with consumers who were actively angry, one of the clients had the potential of someone who could erupt if his barely latent paranoia were provoked.  Because I read this consumer as someone who was manipulative with his anger (more with women, I think) A.Z. could be confronted by someone whose good will was all that keeps the interaction in check.

I am betting that some of A.Z.’s major difficulties are with consumers who have barely suppressed anger and rage issues. This hits too close to home and his ability to keep in the professional box in his head is jeopardized. There is also the sense of urgency about getting things finished or wrapped up that can be fueled by the underlying tension created by a consumer with frustration issues of his or her own.  There is also the safety and security issue that comes up with highly emotional consumers.

Safety is clearly a theme for A.Z. as he goes through his day.

As A.Z. has learned to navigate through the material world and the world of emotions, much emphasis appears to have been on learning survival skills of an external nature. I think if A.Z. knows the rules, he makes every effort – perhaps too much of an effort – to follow them. He has figured out how to cope by following all the overt rules given to him, but many of the unspoken rules of society elude him.

I am guessing that many of society’s unspoken rules appear pointless, so he doesn’t even dignify them by acknowledging their existence. Lots of the “soft” rules in our lives cushion our interactions. “What’s the point?” could well be what A.Z. asks, especially if he can’t see why this particular rule matters to other people. I think that A.Z. might push things away if he cannot find a clear spot for them in his over all scenario of life.  He wants interactions to work well, but has limited models for smooth and intimate relationships.

When one thinks of life as a constant war, as A.Z. does, some of the niceties just don’t compute. As long as A.Z.’s focus is on himself as a foot soldier in the war of life, he will be unable to relax and learn to live with change.

A.Z. is impatient with the perceived failings and shortcomings of equipment and institutions. This is not a fatal flaw.  Equipment and institutions can use continual improvement, but this cannot be accomplished by a solo social worker whose responsibilities are to his consumers. He doesn’t need to the one who fixes it all himself. A.Z. knows this intellectually, but cannot control himself if he gets too far along the “it must work right” thought path.

When things are not working, the issues of priorities and boundaries rear their ugly heads for A.Z.. This is an area that is amenable to coaching, even if A.Z. has to begin with a written script and list of overt rules. The priorities within his workplace can be, and need to be, clarified in A.Z.’s mind. Stress causes a loss of good judgment. Poor decisions lead to more stress. And so it goes.

A.Z. can learn to view the shifting targets of paperwork, teamwork, and consumer service as an interesting challenge, rather than a primal struggle between what is right or wrong.  If he learns to pause before taking action, he can draw on his intelligence, rather than succumbing to his anxieties about performance.

A.Z. has said that he is afraid that asking for help makes him appear incompetent.  A confident individual asks for help, knowing that competence is not an issue. A.Z.’s insecurity leads to poor judgment about asking for help. One difficult lesson for A.Z. will be to understand that his intellect is not always the most reliable guide for solving inter-human difficulties.  It is possible that A.Z.’s reliance on “head” not “heart” approaches to people is what has lead to a statement made to me that “A.Z. lacks empathy.”

Asking for help is a difficult skill for many people.  Assuming that an individual isn’t in a perpetual state of emotional helplessness, anyone who has a hard time asking for help can improve that skill, first superficially, then more deeply as comfort with vulnerability takes root.

I don’t find A.Z. at all lacking in empathy, however, his current approach to consumer problems is rooted in a “we have to do something to fix this” mentality that is partially in his nature, partially his occupational training, and all reinforced by his job setting. 

When faced with uncertainty about what to do for a consumer, A.Z. is likely to reach for tried and true avenues that don’t involve a “let’s wait and review or bring in someone else,” approach.  Because he operates from a sense that everything ought to work the way it says it is supposed to work, he is doesn’t accept what is the majority of life experience: things rarely work the way they ought to work, and even more rarely, the way one wants them to work.

Thus far in A.Z.’s life, his intelligence and intellect have been wrapped around him tightly. This has kept him upright and moving forward through what he often views as a hostile and dangerous wilderness. He has reached a place and time where this is not only inappropriate, but, worse case scenario, could seriously backfire by leaving him unemployed.

It is also possible that A.Z.’s difficulties when consumer needs aren’t being “met” (based on his exacting definition which may or may not be realistic) result from good old-fashioned projection of anxiety and fear about his own struggle with accommodations.  It is not possible to think through a clear strategy for someone else when one’s own fears are calling the shots.

 Clash of Expectations

One of the major challenges for A.Z. in his current job is a serious clash of expectations.  A.Z.’s basic expectations that accommodations will be suitable and functioning, and that his previous training and experience are sufficient for him to perform in this setting, have not been met, for various reasons, including his own behavior.

During some periods, his unfulfilled expectations are thrown back at him several times a day, and this creates a huge amount of stress. 

As a rule, expectations are merely an invitation for suffering. Arriving in a situation thinking that things will work a certain way almost inevitably causes all sorts of unpleasant outcomes. A.Z. has certainly experienced some of these.

However, A.Z. is not alone in letting expectations get in the way of present-time functioning. The team and its supervisor have deeply rooted expectations of how a social worker ought to behave, as well as how a visually-impaired person ought to behave. 

Since the population of visually-impaired persons is no more homogeneous than the population of anyone else, it is unfair to compare one blind person’s skills or lack of skills with another.  “So and so can do that, so why can’t you,” can hardly be viewed as a useful and supportive statement – whether spoken or unspoken.

Teams often assume that new members will catch on to the unwritten subtext of position, behavior, and demeanor. After a brief orientation, the focus of a team is to get new members up to speed on the job actions and paperwork. If this doesn’t happen successfully, it is never the team’s fault, they circle the wagons and point fingers outward. Even the best teams are not immune to the group think that reinforces their values.

A useful question when new members arrive, and as time goes along, might be: “How will the strengths and weaknesses of our new team member require us to readjust? Is this useful and beneficial or does it undermine our overall goals?”

The mandatory probation period makes it more difficult to fully embrace new members as real new team members. I suspect it is uncommon to lose counselors (at this location of EMPLOYER) at the end of the probation period for job related problems. The expectation is that new people will not create too much disturbance in the status quo as they find their place in the scheme of things.  A.Z. has challenged that expectation.

The expectation that counselors will act as consummate professionals, at all times, may be reasonable, but not all individuals come equipped with equal skills. A.Z. does appreciate, intellectually, the difficulty that his lack of confidence and lapses in good judgment can potentially cause at EMPLOYER.

The other expectation that provides a subtle but powerful backdrop to all this may well have to do with A.Z.’s support system. Although he has lived on his own during college, he is now living with his parents. Rather than be “independent” and taking the Queen City Metro to work (he may not be eligible for Access because he is not impaired enough under the current definitions), his mother provides transportation. It is less stressful over all for A.Z. not to ride bus.

The issue, though, is how do A.Z.’s team members regard him because he gets a ride with his mother and he is not “living independently.”  After all, one of the underlying credo’s of vocational rehabilitation is about being as independent as possible. A.Z. does have reasons for currently living at home. I wonder, since this issue arose during a conversation with a team member, if A.Z.’s perceived lack of willingness to be “independent” may get in the way of his being viewed as a professional – a peer among peers.

Again, an expectation that hovers in the background. It might be useful for all parties to examine expectations and state them clearly to one an other.

The issue of “neurological” problems has been raised several times.  Specifically, the question of whether A.Z. might have a pervasive development disorder, or sensory integration dysfunction, has come up. I think that A.Z. has enough wherewithal to become a more skilled communicator, both with himself and others, in spite of whatever underlying neurological issues he has. 

I think at some point it would benefit A.Z. to take up an activity like tai chi, or perhaps aikido. He can explore and chose a physical activity that makes him feel more confident. He also might develop a sounder sense of physical presence as he becomes more centered in his body.

My best judgment is that with support and hard work, A.Z. can make major changes. 

SIX WEEK PLAN

In order to address the urgency which accompanied the request for a coach, I propose a six-week plan, averaging 3 hours of my time a week. If I exceed my estimated hours, the cost will remain the same.

In that short period, I think it is possible to develop some job-related strategies, develop one or two stress reduction techniques, and introduce cognitive skills aimed at acceptance and reducing pessimism.         

I think A.Z. will need longer term reinforcement. None of his challenges rose up over night, or over six weeks, nor will his challenges be addressed quickly. He is on a life long path. He has an active mind that views the world with distrust and will have to work steadily to live more spontaneously and openly.

 I will see A.Z. on Friday, at EMPLOYER and at a client meeting. Since we know that the next two weeks are likely to be stressful, I may opt for more face to face time during this period.

I expect to do once a week session at EMPLOYER and have daily (or more frequent) directed phone conversations and email assignments until the 6 weeks is up. 

I suggest we meet after the six weeks are up and evaluate what has happened.

The Coaching Focus

The areas on which I will focus in face to face meetings (at least once a week) and in daily 5-15 minute phone conversations:

When things don’t work, when it is unclear who should be called, or whose services are appropriate, then A.Z. needs to learn to stop what he is doing, use some simple stress reducing technique like deep breathing, breath counting, or visualization for a set period of time – one to several minutes.

A.Z. (and I) will design a series of steps for him to take when situations arise.  He will decide what he is going to do and I will ask him to document this.

It will be useful to reinforce this by having him stop prior to making phone calls, whether or not he anticipates problems.  The key is to reinforce de-stressing and reflecting techniques so they become second nature.

As part of this process of handling difficult situations, A.Z. needs to establish guidelines for when it is appropriate to “not act.”  Instead of viewing all issues as problems that need immediate solution, he can re-frame this and outline the steps to take.

As we discuss past problems, we can start to work on the areas where A.Z.’s professional judgment meets up with his impatience and frustration, and then he erupts. Ideally, he will begin to get a feel for where he is in danger of losing his professional judgment.

Email lends itself to examining issues in a spontaneous fashion. Via email, I will give A.Z. specific exercises or assignments – sometimes providing immediate feedback if I think we can develop a significant area. Other times, I will simply read and file the emails and see what patterns develop.

Awareness and acceptance as skills will be emphasized and reinforced. A.Z. is in an almost constant state of resistance – both emotionally and physically.  Part of him fears “letting go” for fear everything will explode.

A.Z. shows all the signs of someone whose approach to life is fundamentally pessimistic. This is not irreversible, but it requires lots of self-monitoring and kindness to turn around. This may be A.Z.’s largest challenge. Thought patterns in which difficult situations are viewed as personal, permanent, and pervasive dig one a deep grave indeed. 

There are techniques for unraveling pessimistic thinking. I can help impart technique, but it will be up to A.Z. whether he leaves the comfort zone of pessimism. Pessimism supports internal passivity.  It lets one off the hook of taking complete responsibility for thoughts and attitudes.  A.Z. will have to commit fully to change how he views life, no matter what is happening.  This is a life-long path, but I think we can take some baby steps down it.

email: connie

copyright 2002                     constance lee menefee                  all rights reserved