Case Study 1: Group Case
� Robert—Youngest of the family, 12 years old. Very smart but withdrawn. Tends to be anti
–social and likes to hide in spots where he can remain unseen. He becomes angry when others show him kindness and is very resistant when adults try to talk to him.
� Adam—Oldest of the family, 17 years old. Sweet and timid. He is aware of the dangers presented by his family dynamics. Has been hospitalized multiple times after attempting to commit suicide.
� Abigail—Grandmother, 62 years old. Kind
–hearted and hard working. She received custody of the boys about a year ago. She is trying to do the best she can despite multiple family hardships. She lives alone and has been divorced from her husband for more than 10 years with no contact since. She is open to outside help and is currently receiving financial assistance and counseling from the department of social services (DSS).
Robert and Adam were living in a car with their mother, Victoria, before DSS took the boys from her care. Victoria, a young mother with a severe addiction to drugs, has since disappeared and has not tried to obtain any visitation rights to see the boys. Robert and Adam were unable to live with their father, Jacob, due to Jacob�s diagnosed schizophrenia. Jacob currently lives in an assisted facility, with little to no contact with the family. Jacob and Victoria had a very volatile relationship while together, much of which the boys saw first-hand.
Abigail, their grandmother and closest relative, took custody of the boys and admits that she is finding it hard to care for them. Abigail welcomes the therapy provided by DSS and hopes that it will help them discuss issues that have plagued their family for years. Abigail always attends the mandatory family counseling sessions, as well as a single-parent group offered for DSS custody cases.
During one emotional group session, Abigail revealed that she blames herself for the cause of her family�s problems. Her husband beat Adam and Robert�s father, when he was a little boy. Doctors believed that these frequent acts of violence were what caused Jacob�s schizophrenia. Abigail also suspected that her only daughter, Jenny, was sexually abused by her husband. Abigail, also a product of family incest from her own grandfather, admitted that the warning signs were all there, but she was too afraid to follow through with her suspicion. Abigail disclosed that though Jenny had worked hard to make a good life for herself, she spiraled into a severe depression after her husband divorced her for a transgendered lifestyle. Jenny now has trouble living outside the fantasies that she finds in her soap operas. Abigail believes that both Jenny and Jacob could have lived a better life if she could have stopped her husband from the physical, verbal, and sexual abuse.
Meeting Your Clients:
When Abigail, Robert, and Adam meet you at the park, you notice that Adam stays close by Abigail, while Robert runs through the parking lot on his own. As you introduce yourself, Robert decides to ignore you by walking the opposite way toward the playground. Adam shakes your hand apprehensively and then begins to draw at a nearby table.
As you talk with Abigail, you see her emotions bubbling to the surface as you explain the ways in which you can help her as she begins to care for Robert and Adam. Abigail emphatically tells you that she wants to break the cycle and protect Robert and Adam from further harm. She admits, however, that she is seeing very troubling signs from both the boys. Robert has a habit of hiding under the stage to craft small weapons at his after-
school program. He refuses to talk to her and often throws things when she tries to offer him love and support. Adam has black circles under his eyes and she believes that he has had trouble sleeping. Though he is open to Abigail�s hugs and warm conversations when in private, she notices him refrain and even verbally reject these actions when Robert is around.
The next day, you pull out documentation recently given to you by teachers who work with the boys at school and at the after-school program. Though these teachers do not know the details of the family, their comments reflect similar concerns to Abigail�s. You have met with the boys only briefly, but it is obvious that the pattern of their behavior is very troubling. You must now begin to figure out which resources will help Abigail, Robert, and Adam as they move forward as one family unit.
Case Study 2: Individual Case
� Charlene—Oldest of two and only daughter in the family, 16 years old. Intelligent and caring. Her recent patterns of cutting class to hang out with students known as �the bad kids� has caused her once-high GPA to plunge into the failing range. Teachers have noted that Charlene appears to be very distracted and socially disconnected when in class, traits that they had not previously seen with her before this year.
Charlene�s new and at-risk behavior prompted Kate, the high school guidance counselor, to talk with Charlene. As Charlene walked into Kate�s office, Kate was surprised to see that it wasn�t just Charlene�s school behavior that had changed. Charlene, once known for pulling her long, beautiful hair neatly back into a bun, now let it lay limp in front of her face. Her color-coordinated slacks and blouse were also exchanged for a big jacket and Windbreaker pants. Kate also noted how Charlene seemed to wrap herself inside the jacket—an odd behavior considering how warm the weather was outside.
In talking with Charlene, Kate learned that she felt unsafe at home. Her father, a local handy
–man with a high school education, had a history of coming home from work drunk and belligerent. Over the past year, these actions had transformed into physical and verbal abuse toward Charlene specifically. Charlene had never been on a date with a boy, yet her father constantly accused her of �sleeping around� and dressing like a tramp. Charlene said that she felt her mother was too terrified of her father to protect her from his vitriolic language, rage, and drunken rants that centered on her worthlessness. Charlene confided to Kate that she wanted to safely separate from her father and her current home life. Charlene had not attempted to run away because she did not want to abandon her 11-year-old brother Matthew . Though Matthew did not receive any physical or verbal abuse, Charlene was afraid that her father�s temper would be transferred to him if she were to leave.
Kate called the department of
social services , which found bruises on Charlene�s arms and back. Charlene and her brother Matthew were immediately placed into a foster home until further evaluation and home visits have been conducted with her mother and father.
Meeting Our Client:
Your first encounter with Charlene is at her new foster home. As you greet her in the kitchen, she seems frightened
, yet confident at the same time. Knowing that teens love the occasional junk food, you offer her one of the meals that you picked up from the local fast-food restaurant. As the two of you eat, you casually begin to make small talk about today�s popular music artists. She doesn�t talk much but giggles when you make a bewildered comment about the recent antics of one outlandish pop star. As you continue to engage her in conversation, you turn the topic toward popular comedies that have recently come to theaters. Charlene smiles as you mention one movie that she wants to see. She even excitedly talks about the cast of characters and movie plot. You make her a deal that if she can earn a C or higher on her next test grade, you will take her to see the movie. She agrees and with a sip of your chocolate shakes, this connection with her is your breakthrough for today.
Right now, Charlene is very vulnerable. She has been hurt by the two adults who were supposed to put her well-being above their own. Charlene is 16 and able to make her own decisions about attending school and counseling sessions. These two factors are equally important and make your case management plan two
–fold . First, you must gain her trust and show her that you are there for her during this traumatic period in her life. Second, you must find the best way to coordinate her care in hopes that your interventions will prove to be successful.
Case Study 3: Individual Case
� Jason—Oldest of three children, 27 years old. Likable yet self-destructive. Jason graduated from high school with a C average and has held down consistent yet marginal jobs since. Jason has lived in a small town just outside the city his whole life. Many in town attribute Jason�s inconsistent patterns of behavior to the dissolution of his family during his late teens. Jason is the only one who chose to stay in town and has come to have a reputation for severe drug abuse around the holidays.
Jason was picked up by the police for stealing and riding a horse into the middle of town. The police documented Jason as being disoriented and panicked. He had been passionate about his need to go across the river where his troops were waiting. When asked his name, Jason had replied �George Washington.� The police brought Jason to the local hospital, where he was diagnosed as having a schizophrenic break. A urine sample also revealed traces of drugs in Jason�s system.
Meeting Your Client:
You meet Jason at a recovery center eight months after this first known schizophrenic break. The center is ready to discharge him into a group home with three others who have previously left the center and are attempting to integrate back into the community. As you review the discharge reports, you see that Jason has been taking his medication regularly, as well as attending all counseling sessions with his therapist.
You are scheduled to drive Jason to the group home tomorrow but have arranged for the two of you to meet one another while walking the grounds of the center today. As you introduce yourself and the ways in which you can be a resource for him, you notice that he constantly fidgets with his clothes. As Jason attempts to introduce himself, he seems embarrassed when reflecting on the actions that brought him to the hospital. As a result, he is unable to hold eye contact with you for more than a few seconds.
As the conversation turns to his newly diagnosed illness, he makes a sudden and angry outburst that implies he knew this day was coming. He explains that both of his younger sisters had been in and out of the hospital,
As you and Jason casually shoot hoops at the center�s basketball court, his mood lightens and you can see why people in town believe him to be a likable guy. Jason even jokingly comments that he hopes you will be able to help him control any other past presidents who try to take over his body during his next schizophrenic break.
As you leave the recovery center and begin preparations for tomorrow�s events, you reflect on the complex case that you have ahead of you. You will need to develop an action plan that you and Jason will use as he learns to live with a troubled past and a chronic mental illness.