Case Study: Applying Social Work Theories to Paranoid Schizophrenia

This case study examines Amelia, a 55-year-old woman diagnosed with paranoid schizophrenia, and explores how social work theories can improve her and her family's lives. The study applies Systems Theory, Psychodynamic theory, and Social Learning theory to understand Amelia's condition and develop effective interventions. Systems theory focuses on modifying Amelia's environment to reduce paranoia, while Social Learning theory examines how she can model positive behaviors. The study also considers the limitations of each theory, particularly the Psychodynamic approach, and emphasizes the importance of holistic, patient-centered interventions to help Amelia regain control of her cognitive abilities and improve her social interactions. The case study highlights the complexities of treating paranoid schizophrenia and the need for adaptable social work practices.

Running Head: CASE STUDY: PARANOID SCHIZOPHRENIA 1
Title: Case Study: Paranoid Schizophrenia
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Introduction
Schizophrenia is a type of psychosis, in which the patient has a distorted perception of reality. In
paranoid schizophrenia (Venter, 20212), the patient additionally has paranoia, profound fear and
anxiety, in which they feel that they are being unfairly persecuted, even when there is little
evidence of this being the case. In this case, study, we explore the case of Amelia, a 55-year-old
woman who has been diagnosed with the condition at the Royal Melbourne Hospital. She lives
with her family, which includes her husband, and two teenage children. One older offspring has
already left the house, and is in college. This case study will explore how social work practice
theories can help her and her family lead a more fulfilling life.
Social work theories
In social work practice, social workers faced with a case such as Amelia’s can rely on a few
theories. IN the context of this case study, we will explore the Systems Theory, Psychodynamic
theory, and Social Learning theory. Systems theory looks at the individual as part of a system,
and considers the input of other people and circumstances that the individual interacts with to
understand the best way to intervene (Steggles, 2012). Psychodynamic theory suggests that
human behavior is a product of the conscious and unconsuous mind. The unconscious is made of
the id, ego and superego. Social Learning theory holds that individuals learn behavior through
observation, and then modelling their behavior on the earlier observations (Gregory, 2010).
This case study will apply Systems and Social Learning Theories. With systems theory, the paper
will examine how the environment in which Amelia lives in can be used to successfully
intervene to make her condition better, besides the use of medical interventions. With Social

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learning, the paper will examine how Amelia can avoid her destructive behavior through
modelling and how her behavior can be modified to rid her of paranoia (Caqueo-Urizar, 2015).
Systems theory
Systems theory holds that a person’s behavior, needs and experiences give rise to a person’s
behavior. In the case of Amelia, all these experiences must be examined. She lives with a family
that, while they are supportive of her, may not be helpful. She may view their actions with
suspicion, such that she cannot accept any help from them. Amelia is a strongly religious person,
and sees their actions as a manipulative plot aimed at weakening her, or ensuring that she does
not succeed at all. Amelia has also had disagreements with her husband, which greatly shook her
trust in him and with her social networks as well. In short, she lives in an environment, which is
highly toxic.
According to systems theory, social work should focus on ensuring that the environment within
which she lives is healthy, and helps eliminate the paranoia. This as she continues alternative
medical interventions at the Royal Melbourne Hospital to cure her schizophrenia. Her social
work intervention will include not just her immediate family, but also any social groups such as
her church, past colleagues and friends, and any other interactions. It is expected that with such
an interaction, Amelia will recover.
The reactions that Amelia has can be described as defensive mechanisms to her perceived
persecution. This needs to be countered by showing that this is not the case, and negative the
need to defend herself. She also suffers from disorganization, where the roles of other people in
her life are confused, and she ends up feeling vulnerable. This disorganization is a primary cause

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of the paranoia, and must be countered before even the defensive mechanism can be remodeled
to actually deal with her problems.
The system in which Amelia lives in is constantly changing. Her children are growing older, as
she and her husband are. She the system must therefore be adapted to not make her even more
delusional, but show her that this is a normal part of life. The system must be looked at
holistically, so that no part of her interactions, no matter how minimal, are ignored. In all, her
behavior is nothing more than the sum total of her interactions with the system. Therefore, it
must be taken as a whole. Amelia must be given the lead in the intervention. It will be patient
centered, meaning that her unique characteristics will be the main drier of any intervention
(DeVylder, 2015).
Social Learning theory
People with schizophrenia do not respond to their environments the way normal people without
the condition would. Instead, their idea of reality is twisted and in some cases, harmful to their
well-being. This is especially so in the case of paranoid schizophrenia, the type that Amelia
suffers from. For Amelia, she is unable to be as attentive as she should to social triggers and
stimuli, leading her to have a deficiency in the way she responds. She then fails to have proper
association with the social environment, and eventually, this affects her surrounding social
associations as well, including family and friends (Rufallo, 2019).
According to Social Learning theory, this is all because she learns social cues and behavior in a
different way. If she were to have a normal and healthy relationship, without the condition, this
would not happen. Whatever she learns, and models her life on, is twisted. For instance, the
efforts of her husband and other family members to help her are not seen as genuine efforts to do

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so. Rather, they are seen as an attempt to harm her. She develops a harmful defensive mechanism
that is not beneficial (Simonsen, 2019).
With social learning, the social worker can help her perceive events and behaviors differently.
She can then try to learn and implement such behaviors. By modelling her behavior as a normal
person would, it will assist not only her, but also her social circle to respond better to the issues
that she faces. Person with the condition that Amelia suffers from needs not control, but
guidance. By trying to enforce control, Amelia will see this as a ploy to harm her, and resist it
strongly. Guiding her will however have a more positive effect in shaping her behavior and
enabling her regain normalcy and a better idea of the reality around her (Scherzer, 2012).
There is a reason why schizophrenia is termed in some circles as a disease of civilized society. In
less developed societies, social bonds are stronger. People with schizophrenic tendencies or
symptoms are easily reintegrated into society through stronger support mechanisms from their
family and friends. This inversely means that a social worker would have several other means of
enacting social learning theory and expecting better results from the people. At the same time, it
would be easier to model behavior when the cues are more easily accessible and applicable, as to
be better modified by the patient.
The case is not so easy in a modern western society, where social interactions are not as close as
in other places. For instance, Amelia may not always be around other people all the time. This
time spent alone will be a fertile ground for blurring reality, and reduce interactions with family
members and social workers. The result will be a situation in which she is unable to model any
good behavior. Rare and sporadic interactions will only be seen negatively, and diminish her
chances of social learning and cognition.

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It can be expected, however, that with strong social learning backing and a social worker whom
id adaptive to the situation, the theory would work, and Amelia may yet regain total control of
her cognitive abilities. For instance, the social worker would encourage family members to be
closer to Amelia more often, reducing the amount of time she spends together. They also need to
be coached to react in a good way even when she is defensive and wary of their positive attempts
to help her. With time, and with the guidance of the social worker, it is expected that she will be
better equipped to recover.
A major weakness with social learning as an intervention medium is that the social behavior that
Amelia needs to observe and modify her behavior on may simply be lacking. The social worker
may not have much to rely on other than aggressively encouraging others to take part., without
this, she may have no other option than to resort to other theories and interventions to help the
client.
Psychodynamic theory
Unconscious processes are a key determinant in shaping a person’s judgements, feelings, and
behavior. This is the thrust of psychodynamic theories by Sigmund Freud, who saw the
unconscious mind as a key determinant in shaping behavior. According to the theory, our
childhood experiences have a key effect on how our adult lives fan out. Personality and our
response to experiences as adults are therefore a product of what we went through as children
(Trifu, 2015).
While the theory may be an important help for social workers in many circumstances, several
issues would prevent its working in the case of Amelia. While it is true that our unconscious
mind – id, ego and superego are all important in making judgements and defining our feeling s

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and emotions, this may not be the case in instances where we have issue as Amelia does. Her
reality and her unconscious self are all heavily disorganized, such that she lives in a world of her
own. This greatly affects her reaction to stimuli.
It must also be pointed out that Amelia’s issues that necessitate social work interventions are not
necessarily the result of her childhood experiences. She is actually suffering from paranoid
schizophrenia, which has been clinically diagnosed. Amelia may not be helped so much by the
use of a therapy that draws upon her childhood, when she was in another country, several
decades ago, as a means of helping her overcome her condition. This is not to say that her
childhood has no bearing on her current perception of affairs. Nevertheless, it would be more
accurate if she had a better grasp of her reality.
Our behavior is not entirely caused by our unconscious self, as the psychodynamic theory tries to
imply. Modelling behavior may happen because of both experiences we encounter consciously,
and others, which we only realize subconsciously. So, while the psychodynamic theory may
look at our unconscious experiences and use them to come up with an intervention, this will not
really be helpful. An intervention needs to be as holistic as possible, considering not just
experiences, but also our interaction with them, and guiding the patient to have a different
reaction to them. In the context of this theory, the intervention will not be holistic; neither will it
pay sufficient attention to social experiences in the current circumstances.
Conclusion
Different theories have been advanced as being the perfect source of intervention when dealing
with schizophrenics. With each theory, there are potential weaknesses that may derail the
process, due to an inability to consider every part of the condition at hand. Paranoid

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schizophrenia has added complexities, too. It demands that the social worker identify the social
experiences that a person interacts with, and other parts of their system. It also understands that a
person’s behavior is shaped not only by their early experiences, but also by the behavior they see
around them, and how well they are able to mimic it.
Amelia’s experiences need to be modelled after what she sees, and she needs to be guided, not
controlled. Thee social learning theory will be greatly beneficial in this. The need to look at her
system holistically to have a chance of prescribing a successful intervention will also ensure that
the systems theory works well to help her overcome her condition.

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References
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DeVylder, J. (2015). An Ecological Systems Perspective on the Clinical High Risk State
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Gregory, V. (2010). Cognitive-Behavioral Therapy for Schizophrenia: Applications to Social
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Rufallo, M. (2019). Understanding Schizophrenia: Toward a Unified Biological and
Psychodynamic Approach. Psychoanalytic Social Work, 26(2), 185-200.
Scherzer, P. (2012). A study of theory of mind in paranoid schizophrenia: a theory or many
theories? Frontiers in Psychology, 14. doi:10.3389/fpsyg.2012.00432
Simonsen, A. (2019). Socially Learned Attitude Change is not reduced in Medicated Patients
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