DSW Program Personal Statement Hospice Indian

Indian Immigrant Woman's Journey in the DSW Program: A Personal Statement of Empowerment and Social Work Commitment.

From a young age, I recognized the profound impact of simply listening. I would spend hours at dinner parties conversing with each ba (older woman) and dada (older man), often being the only young girl not playing with the other children. Their stories captivated me, detailing their lives in India, reasons for immigrating to the United States, and what they missed most about their homeland. I learned to observe the storyteller's eyes, which often conveyed as much as their words. While the specifics varied, the themes were consistent. Many had moved to the U.S. because their children had settled here. In India, children, especially sons, are expected to care for aging parents. Being far from home, these elders frequently expressed a sense of loss: of their homeland, purpose, and societal role.

Family experiences also nurtured my interest in immigration issues. My maternal grandmother sought asylum here after her son was brutally beaten during a military coup in Fiji. Today, she exhibits somatic symptoms of depression like dizziness and stomach aches, yet seldom seeks medical help. “It's my destiny to feel bad; I must have done something wrong in my past life—it's my karma, and neither I nor a doctor can fight it.” This perspective on one's life is typical of traditional Indian culture. My paternal grandmother refused to leave her home in Zambia to join her grown children, saying, “I don't want to follow my children to America and fall into a black hole like my friends have.” Tragically, she was later murdered by her housekeeper of 40 years in the country she loved. Although I often felt deeply saddened and sometimes angered by my grandparents' experiences and those of other elderly community members, I remain fascinated and eager to listen to these stories for years to come, thriving on the power of simply listening. Engaging the elderly in their life stories can provide a sense of purpose and meaning to their past. I believe that to have hope for our future, we must find meaning and purpose in our past. This belief inspired my desire to become a social worker.

As I gained more experience, I realized the value of an advanced degree. Obtaining a DSW will provide me with the academic credentials needed for career advancement, along with the tools to develop effective programs, contribute to policy and practice changes, and conduct essential clinical research in a neglected area. With a doctoral degree, I aim to better assist the local communities I serve by developing evidence-based, clinical programs that address community needs. I hope to play a significant role in higher education, engaging young minds to explore aging and provide crucial services to a rapidly growing population segment requiring substantial care. I also look forward to deepening my understanding of my own feelings, attitudes, and relationships with clients—all critical to the helping and healing processes that underpin professional maturation.

By pursuing a DSW degree at the University of ____, I will immerse myself in cutting-edge research on best practices and explore a wide range of evidence-based theoretical approaches, scientific principles, and expert insights vital to my success as an advanced practitioner. I am particularly drawn to the DSW program at the University of ____ because of faculty like Dr. ____, as my research interests closely align with his work on caregiver burden. My interest in caregiver burden stems from extensive professional experience in home care and as a hospice social worker. I have witnessed many cases of caregiver burden and its lasting impact on caregivers' physical health and mental well-being. I believe it is crucial to better identify factors that increase susceptibility to caregiver burden, enabling us to provide more appropriate and effective support. Additionally, I believe different cultures have distinct risk factors that affect the nature and intensity of caregiver burden. Therefore, identifying these culture-specific risk factors is essential for providing competent care to an increasingly multicultural society.

While working as a clinical social worker for a hospice company, I encountered a particularly challenging case that highlighted the need for culturally competent services in hospice care. I received a call from a hospital social worker about MJ, a 66-year-old woman who had immigrated to the United States from India. She was diagnosed with an aggressive form of neck cancer. I met her shortly after her third emergency room visit in two months. Her tumor was deemed terminal, prompting her oncologist to order a hospice consultation. The hospital discharge planner informed me that the patient needed to be discharged within a week. The patient did not want to return home with her daughter. She was ineligible for state assistance, lacked Medicare benefits, and did not have sufficient funds for assisted living or a nursing home.

Upon entering MJ’s room, she remarked in English, “A desi (Indian) girl, now are they going to get me some desi food.” We quickly formed a bond; MJ was humorous, articulate, and cherished Indian culture. I soon discovered she had significant unresolved issues, starting with a rape in India 35 years ago, which she needed to address urgently. MJ lived with her daughter, her primary caregiver, yet she refused to return ‘home’ with her daughter. “I would rather die in the hospital than go back there. My daughter is no good! I can’t tell anyone here, but since you are desi, I know you will understand.” In the United States, where patients are expected to make their own decisions, it can be overwhelming: “I can't make a decision about hospice care; a sick person should not have to make such difficult decisions.” After several more conversations, she admitted, “I'm not ready to die; I have a lot of problems that need to be fixed, and I am feeling really down about it. My daughter and I don't get along. I have not spoken to my Aunt in India in over 35 years.” I understood that MJ's feelings were not uncommon. Many older adults I had worked with faced similar fears and feelings of inadequacy when reflecting on their lives, and like MJ, many experienced anxiety and depression if these feelings remained unresolved. I knew that for MJ to accept her diagnosis comfortably, she needed to address her unresolved issues. Reminiscence therapy can often be beneficial in such situations, helping clients deal with unresolved emotional issues.

I started using reminiscence therapy techniques with MJ. After a few days of exploring her past, she gained insight into the source of her anger. Her parents had died suddenly in a car accident when she was sixteen, forcing her to live with an aunt she barely knew. At nineteen, she was raped and gave birth to her daughter as a result. She fled to the US with a male friend, who eventually left her for an American woman. When working with hospice patients, I often employ short-term therapy techniques to help individuals cope with events causing emotional, mental, and physical distress. Many of the people I worked with had limited time to address these issues due to their terminal illnesses; however, these unresolved issues caused significant stress and anxiety. After MJ shared her past, I began meeting with her daily to help her process her emotions. Through daily individual therapy sessions, she realized she struggled to maintain relationships due to a fear of abandonment. MJ was concerned about her relationship with her daughter, feeling unloved by her. So, I scheduled family therapy sessions following MJ's individual ones. Family therapy provided MJ and her daughter a safe space to express their feelings.

Through family therapy, MJ gained insight into her anger and its negative impact on her relationship with her daughter. Both MJ and her daughter wanted to reconcile, and to maintain a healthy relationship, new boundaries and structures had to be established. Using cognitive behavioral therapy techniques, MJ and her daughter began respecting each other, setting boundaries, and healing their relationship. Within seven days of daily visits and various therapy techniques, MJ decided to move back in with her daughter and accepted hospice services for additional support. MJ was in hospice for four months before she passed away. During that time, I visited her weekly, continuing reminiscence therapy. "Storytelling," as MJ called it, helped her connect the dots and understand the issues that had affected her for years. In Sanskrit, we say: “A secret is like the skin of a leper; it eats away at you until you die.” On our last visit, MJ confided: “I no longer have any secrets, I feel more alive now than I have in the last 35 years.” She died peacefully in her daughter’s home, with her daughter and her aunt from India by her side. MJ likely wouldn't have utilized hospice services without culturally competent care. She helped me realize the urgent need for culturally competent services in hospice care in our increasingly diverse America and the importance of using therapy techniques like reminiscence therapy in culturally specific contexts.

At the start of my social work career, before obtaining my MSW, I wasn't fully aware of the theory behind my methods. Now, I understand that cultural competency was the main theoretical framework guiding my early social work practice, in both individual and group therapy, and in helping organizations develop policies, programs, or training. I generally focused on the cultural aspects influencing care and developing appropriate intervention strategies. While I still view the cultural competency framework as a natural extension of my personality and the core of my clinical practice, by the time I was pursuing my MSW, I was already employing a variety of theoretical techniques. Initially, I struggled to apply theory in practice. However, with more experience and study, I became more adept and conscious of my application of theoretical models. The idea of choosing "one" theory to guide my clinical practice never appealed to my unchained way of thinking.

Particularly due to my work with people from various cultures, I've become increasingly aware of the need for a holistic approach in my clinical practice. Questions like: What if the theory I choose isn't sufficient for all my clients? Will the agency I work at influence my theoretical approach? Will sticking to one theory limit my ability to see other perspectives, potentially not meeting clients' needs? These questions led me to develop an eclectic approach to my clients’ individual needs based on a holistic assessment that includes cultural factors.

In the field of aging, I've found it essential to have a conceptual framework that relies on multiple theoretical models, always considering the interconnectedness of human behavior, life experiences, and culture. Social work theory related to the eco-system concept is the overarching framework that binds my philosophy of specialized clinical practice, allowing for the application of diverse conceptual, practical, and productive approaches. When working with hospice patients showing signs of anxiety and depression, I often incorporate life review or reminiscence therapy into their treatment plans. Many patients, especially at the end of their lives, find closure on unresolved events deeply satisfying. Solutions-based brief therapy has also been successful with many of my patients. For some, focusing on the present works better than focusing on the past, and they seek practical tools and skills to achieve their goals. When working with caregivers experiencing caregiver burden, I've used techniques from strengths-based and empowerment therapy. Helping clients understand the multifaceted nature of caregiving, while focusing on what they do well, often empowers them to ask for what they need. Generally, experiential-based family therapy and behavioral models are particularly useful for identifying maladaptive behaviors and defining and implementing new communication styles.

With the support of your esteemed faculty at UXXX, I hope to investigate the effectiveness of Reminiscence Therapy in addressing unresolved issues and improving life satisfaction among older immigrant populations enrolled in hospice programs. I also want to explore how Reminiscence Therapy helps caregivers, often their adult children, bond with the older immigrant, enhancing life satisfaction at the critical end stage of the older immigrants’ life. I am not yet aware of any research on reminiscence therapy specifically for older, first-generation immigrants and their caregivers, despite older adults comprising over 12 percent of the immigrant population in the United States, a number expected to grow as parents continue to follow their immigrant children to America. Furthermore, there is limited research on therapeutic interventions by social workers in hospice settings, and none that I could find addressing the unique needs of older immigrants and their caregivers.

In my experience as a clinical social worker in hospice care, I find that social workers often use the phrase “difficulty coping” without further detail on the nature or degree of the impairment, or any intervention taken in response. Social workers need training to use specific clinical interventions when working with all hospice patients and their caregivers. These interventions can reduce anxiety, depression, and help with unresolved issues, improving overall life satisfaction. While these issues need addressing for both immigrant and non-immigrant hospice patients, I hope to specifically study how Reminiscence Therapy can enhance life satisfaction for older immigrants and their caregivers by improving the caregiver/care recipient relationship through resolving unresolved issues. I hope that exploring this clinical issue will contribute significantly to social work practice by helping us better understand the dynamics and challenges faced by older immigrants in hospice settings, particularly regarding their relationships with their caregivers.

Thank you sincerely for considering my application to your program.

DSW Program Personal Statement Indian