Why am I Here? Engaging the Reluctant Client
by Carol Tosone
Two vignettes depict social work students handling their most challenging cases with resistant clients, and later meeting with their supervisor to analyze their experiences.

Social work practice often presents challenging cases and resistant clients. Such cases can be difficult for interns to handle, but with the help of an experienced supervisor, they provide valuable learning experiences for the future social worker.

Why Am I Here? advises social work students to ask themselves why they entered the often challenging profession, and consider the question from the perspective of clients as well. Dr. Carol Tosone, associate professor at NYU's Ehrenkranz School of Social Work, hosts the video and supervises the students portrayed in the film. The video's two vignettes are based on actual mandated cases, and illustrate common scenarios in working with resistant clients.

The first vignette follows Jennifer, a first-year social work student meeting her very first client, Alice. Alice is a 44-year-old pregnant woman with an unstable home life and multiple psychiatric diagnoses. She is in the hospital again, for her fifth psychiatric admission in two years. An anxious Jennifer meets with Alice in the hospital, and quickly realizes that Alice is distrustful of her because she is an intern rather than a licensed social worker. Jennifer tries repeatedly to get answers to certain questions, but finds the interview challenging as Alice becomes agitated and unsatisfied with Jennifer. Jennifer ends the session abruptly and later seeks help from her supervisor for what she felt was an "awful" meeting. In supervision, Jennifer receives reassurance and learns how her countertransference impacted the direction of the session. Her supervisor helps her analyze the real messages underneath Alice's agitation—the manifest and latent content. She also draws a parallel between the anxiety Alice and Jennifer were both feeling in the session. What seemed like a disastrous first meeting culminates in an enlightening supervision which provides viewers with tremendous insight.

The second vignette follows Kim, a second-year social work student who is meeting with her first adolescent client, Anthony. Anthony is a 15-year-old high school student and graffiti artist who has been living with his aunt since his mother's arrest. While the first vignette depicted a difficult client who was agitated, this case illustrates another type of difficult client—a silent one. Anthony demonstrates his unwillingness to be in counseling by displaying angry body language and refusing to answer anything Kim says at the beginning of their session. Kim tries idea after idea to engage him, but he continues to challenge her. Although she makes some progress engaging him toward the end of the session, she returns to her supervisor with questions and frustrations. Kim's supervisor helps her see the importance of starting where the client is. She points out aspects of the session in which Kim's agenda or ideas overrode the actual message that Anthony was trying to communicate. Kim also learns how simple changes in language can make a huge difference in putting a client at ease, and the significance of latent content in working with resistant clients.

Why Am I Here? presents viewers with two of the most common types of challenging clients social workers encounter. The combination of the vignettes and the rich supervisory perspective make this video a valuable learning tool.
In Depth
Anyone who has encountered difficult clients or challenging cases will relate to this video. Watching the vignettes will help you consider what you would do in the situation, and the supervision clips will help you analyze your ideas on a deeper level. You'll gain a better understanding of why some clients are so resistant, and how to engage them without forcing your own agenda. You'll also learn to pay closer attention to the subtleties of your sessions by watching for them in these cases and then thinking about the supervisor's observations.

From watching this video, you will:
  • Watch two common examples of challenging cases and become aware of your countertransference reactions and how they may impact your sessions.
  • Learn ways to engage resistant clients including starting where the client is and respecting his or her defenses and right to self determination.
  • Be able to decipher a client's nonverbal communication and distinguish between manifest and latent content of a client's communication.

Length of video: 00:44:35

English subtitles available

Group ISBN-10 #: 1-60124-494-0

Group ISBN-13 #: 978-1-60124-494-9

Dr. Carol Tosone is an associate professor of social work and recipient of the NYU Distinguished Teaching Award. Dr. Tosone, who joined the NYU Silver School of Social Work faculty in 1993, is a Distinguished Scholar in Social Work in the National Academies of Practice in Washington, DC. Dr. Tosone was selected for a Fulbright Senior Specialist Award for teaching and research at the Hanoi University of Education in Vietnam. She also taught as Distinguished Visiting Lydia Rappaport Professor at Smith College for Social Work. Dr. Tosone received her certification in psychoanalysis and psychotherapy from the Postgraduate Center for Mental Health, where she was the recipient of the Postgraduate Memorial Award.

Prior to her appointment at NYU, Dr. Tosone was an assistant professor of social work in psychiatry at Temple University School of Medicine in Philadelphia, PA. She is editor-in-chief of the Clinical Social Work Journal and serves on the editorial boards of Social Work in Mental Health, Social Work in Health Care, Psychoanalytic Social Work, Psychoanalytic Perspectives, Smith College Studies in Social Work, and the online journal Beyond the Couch. She also serves as a consulting reviewer to numerous other psychotherapy journals and publishers.

Dr. Tosone is series editor for Essential Clinical Social Work Series published by Springer; co-editor of three books, Love and Attachment: Contemporary Issues and Treatment Considerations, Short-term Treatment, Doing More with Less: Using Long-term Skills in Short-Term Treatment, and Contemporary Clinical Practice: The Holding Environment Under Assault; and author of numerous professional articles and book chapters. She has also served as the executive producer, writer, and narrator of educational and community service media, including Why Am I Here?: Engaging the Reluctant Client; Feel Free to Feel Better: FEMA Trauma Training; Rewarding Challenges: Social Work with Older Adults; The Greying Elephant in the Room: Substance Abuse and Older Adults; Look Back to Move Ahead; Look Back to Move Ahead: Social Work with Survivors of Trauma; and No Periods, Only Commas: A Portrait of Tiffany.

Dr. Tosone has been quoted or cited in the New York Times, as well as other newspapers and magazines as an expert on trauma and women’s issues. Dr. Tosone has served as a visiting professor or guest lecturer at several international universities, including Hyllum University in South Korea, Sanata Dhara University in Java, Tonjgi University in Shanghai, and Peking University and China University of Political Science and Law in Beijing. Dr. Tosone’s primary research interest is clinician exposure to collective trauma. She has served as a consultant to Psychology Beyond Borders in Indonesia; a member of the Doctors without Borders Hurricane Sandy Mental Health Response Team; and as a consultant to UNICEF and the Afghanistan Ministry of Labour, Social Affairs, Martyrs, and Disabled in the development of National Occupational Skills Standards for Social Work. Since joining the NYU faculty, Dr. Tosone has delivered over 100 professional papers and presentations in academic, medical, and mental health settings in the United States, as well as international venues in Asia, Australia, Europe, the Middle East, and South America. 
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