2 Discussion Posts

Working With Clients With Disabilities: The Case of Valerie

Valerie is a 56-year-old, heterosexual, African American female. She receives Social Security Disability Insurance (SSDI) and works part time at a credit card company as a telemarketer. She currently lives in an apartment alone but receives home attendant services for 5 hours a day. She lost her left leg when she was hit by a car and has a prosthesis. She uses a walker or an electric scooter to be ambulatory but generally prefers the scooter. She is slightly overweight, which makes using the walker more painful. She has been prescribed Zoloft® (100 mg per day) for general anxiety and has been taking it for almost 3 years. Valerie has a history of drug and alcohol abuse, although she has been drug free for 15 years. She has a core group of friends she has maintained a relationship with over the course of her lifetime, and although she does not see them as often as she would like, she keeps in touch over the phone and through email. She has no criminal background.

Valerie came for services to address unresolved feelings related to an abusive marriage. She continued to be in contact with her ex-husband, John, although they had been divorced for almost 13 years. Valerie said that she and John had remained intimate since the separation and divorce and that John texted and called her to meet for sex. She felt torn because she believed no one else would want to date her due to her disability but also felt John was using her. She also stated that although he had stopped hitting her, he continued to be verbally abusive. She remained anxious and depressed and felt hopeless about the situation.

Valerie said John abused alcohol and began using drugs in the first few years of their marriage. Unaware of his illicit drug use, Valerie arrived home from work early one day to surprise him and found him using cocaine. John attacked her and forced her to use cocaine as well. She relented due to her fear of continued assault. An ongoing pattern of drug use and physical assault persisted throughout their marriage.

Valerie lost her left leg when she was walking across the street and was hit by a car, and she spent close to 9 months in the hospital and a rehabilitation program. She was fitted for a prosthetic leg and given an electric scooter through her insurance company, which allowed her to begin working part time at a credit card company when she returned home. John’s abusive behavior and drug use continued, so Valerie hid her paychecks, slowly saving her money until she had enough to leave. Eventually, she was able to rent a room. In addition, she was able to secure the assistance of a home health aide.

Valerie began individual and group sessions to address her feelings of depression and anxiety. I worked with her to set manageable goals to increase her independence in physical functioning and from her ex-husband’s controlling and abusive behaviors. Valerie and I agreed to use cognitive behavioral therapy to address her continued negative thought patterns that affected her behavior. Valerie shared many insights into her disability to help me understand how she felt in a world that was not very accessible. Through our meetings, I learned about the Americans with Disabilities Act (ADA) and how inaccessible buildings and programs affected her quality of life. We met once a week for 3 months, and I monitored Valerie’s depression through a baseline and then periodic administrations of a depression screen using the Beck Depression Inventory.

After 12 weeks, we decided together it was time for termination. She reported fewer episodes of anxiety and expressed feelings of hope for the future. She continued to attend the group sessions and found new friends who had become a support network for her. She had stopped seeing her ex-husband and changed her phone number to prevent him from contacting her.