Speaker 1: I just want to verify when her last appointment was. So she missed one appointment, or... Okay, two. Wow. Thanks. You too. Ashley? Oh, hi. Are you okay? I'm fine. It's been such a rough day. I just got back from a tough home visit. What's up?

Speaker 2: I was just stopping by to give you back this file. Do you have a moment to talk about the home visit?

Speaker 1: Yeah, sure. So tell me what's going on. I had a home visit with a client who recently stopped coming to the outpatient treatment program for opioid addiction. I drove over an hour to meet with this woman. I step into her trailer and she won't even look me in the eyes. All she gives me are one word answers and everything is a mess. She stopped taking buprenorphine, missed her last two appointments that I set up for her here, and it's pretty clear to me that she's still using. It's so frustrating working with addicts. I just don't know how to get through to her. All I want is for her baby to be born healthy. I'm trying to get this woman treatment so she'll have the chance to keep custody of her child, but she doesn't care.

Speaker 2: Okay, I can tell this is upsetting. And I know it's difficult working with individuals with opioid addictions. Some of your colleagues have shared similar frustrations, but I think there's more here we need to discuss. We will have to get to our team meeting, but I'd like to schedule some time to talk more. When is your next meeting? Next week on Wednesday. Okay. Let's try to check in before then. Sure. Thanks.

Speaker 3: Let's see how Ashley and Caroline's next conversation goes.

Speaker 2: Ashley, I was concerned about the conversation we had earlier this week about your home visit. I know work is hectic for everyone, but I want you to know that I hear your frustrations. Thanks. I think I was just having a bad day. Maybe, but I want to help you improve your relationship with this client.

Speaker 1: I appreciate that, but I don't know if this one client is the problem. I think I'm overwhelmed. When I started working here, I didn't expect to deal with the opioid crisis 24-7, but now I feel like it's all I do. I've worked with clients who've faced tough situations before, but usually working with pregnant women and new mothers is more hopeful. I mean, they want what's best for their children, you know? It's incredibly frustrating to work with a client who seems like they don't care about the future and have no interest in changing, even when their unborn baby's health is at

Speaker 2: stake. Tell me a little more about why you think this client does not have any interest in changing. What social or environmental barriers have you considered that may be affecting her adherence

Speaker 1: to treatment? I got the impression that she didn't care about anything as soon as I stepped inside her trailer. Everything was dirty and broken. No effort to clean up or fix anything. She was so detached and avoidant. I've considered that her lack of stable housing and reliable transportation may be barriers for her, but I'm not confident that even if we found her a reliable mode of transportation that she's interested in getting any help.

Speaker 2: I just wish she cared. Let's take a step back for a second. It seems to me that you are making some assumptions about your client based on her socioeconomic status. This may be affecting your ability to understand the factors that are preventing your client from maintaining a healthy pregnancy. Have you noticed any class differences between you and your client? How do you feel about that?

Speaker 1: I don't think that's a factor. I'm used to that. Okay, I'll admit that I don't know what it's like to walk in her shoes, and maybe I made some assumptions that I shouldn't have based on what her home is like, but I want so badly for her to have a healthy pregnancy, and I can't understand why she doesn't seem to want

Speaker 2: that for herself. So is that where your frustration is coming from? You want your client to have a healthy pregnancy, but she doesn't want it for herself?

Speaker 1: I think so. I really value those who care for others, so it's really hard for me to work with someone who resists treatment and harms her baby. It makes me think she's being selfish.

Speaker 2: I just can't help but feel like she's wasting my time. Ashley, you are working with a client whose actions contrast sharply with your values, so meeting her where she's at is challenging for you, but I also know that you are incredibly caring and capable of understanding and working with this client. I want to help her. I'm just not sure what to do. It's important to be aware of our unexamined biases. Our society often sees poverty and addiction as moral failures, and even though we know better, we may still hold implicit biases. To prevent blaming the victim, it's important for you to understand how your client's difficulty in adhering to treatment, her living conditions, and her attitude towards you are informed by her ecological context. I want you to try to keep working with this client a little longer. Be aware of the biases that may emerge as you're working with her. Okay. Ashley, I know you are passionate about the work that you do and that you want your client to have a healthy pregnancy, but right now, it's also important to focus on understanding your client and understanding the challenges she faces. Okay. I'll try to do that.

Speaker 1: I'll let you know how the next visit goes.

Speaker 3: After Ashley's next home visit, she meets with Caroline again. Let's see how their conversation goes.

Speaker 1: How did your last home visit go? It was better than before. I'm concerned she's still using, but during this visit, I tried to get a grip on my judgmental thinking, examine my countertransference, and let her lead. I can honestly say she was more open in discussing her triggers with me than before.

Speaker 2: I think you're on to something. Taking a step back and recognizing our limitations is important. If you're open to it, I would suggest that you take some time to discuss your feelings with your coworkers who work with clients who use opioids. I will also continue to work with you until you feel more comfortable working with this

Speaker 1: client.

Speaker 2: Thanks. I really appreciate that. Of course. This work is challenging. It's not always easy facing our biases, but we must remain open-minded. We are in a continuous process of understanding ourselves and understanding how to best serve our clients.