For Sasha

SOWK110_04 Case Study 2

Case Description

Camila was a 51-year-old female who identified as black and Latina. She was unmarried, unemployed and lived alone. She identified as a strong Christian but had recently stopped participating in religious activities. She had two grown children and had one deceased daughter. One of her children lived out of state and her other child lived in the area with his own children.

Camila presented to an outpatient clinic for treatment of chronic depressive symptoms that had increased since the death of her daughter 3 years ago. Camila stated that a relative had encouraged her to seek treatment but that she was not very hopeful that it would help.

At intake, Camila reported a 23-year history of depressive symptoms. She denied seeking pharmacotherapy in the past or currently. She noted that she had briefly attended supportive psychotherapy (six sessions) from a community mental health clinic about 15 years ago when her initial depressive symptoms began to escalate. Camila reported that while she enjoyed this experience, she did not believe that psychotherapy was helpful in reducing her depressive symptoms and discontinued treatment. Last, Camila reported a history of severe negative life events. Specifically, Camila reported that her brother had died 17 years ago after being physically beaten as part of a gang-related violence, and that she was a victim of childhood physical abuse, victim of domestic abuse, and experienced the sudden unexpected death of her daughter due being hit by a drunk driver.

Camila arrived early to meetings and appeared to be appropriately dressed and groomed. Camila’s reporting style was detail-oriented and at times tangential. She was cooperative and answered most questions. Her affect was very controlled and unwavering even when discussing emotionally charged topics. Camila struggled when responding to questions about what her life would be like if she was not depressed. She held long silences and looked at the ground while shaking her head in response to these questions. Camila stated that her daughter had died approximately 3 years ago; however, she refused to answer any other specific questions related to her death at intake.

Camila’s symptoms included sad mood, anhedonia, appetite changes, difficulty sleeping, loss of energy, and feelings of worthlessness and guilt. Camila was approximately 28 years old when these symptoms first began. She denied that these symptoms caused her significant distress or impaired her ability to function in any life domain. However, Camila reported feeling “bothered” by the depression. Despite Camila’s denial of distress or impairment due to her current depressive symptoms, some evidence suggested otherwise. For example, she reported that these symptoms caused her to have low-quality social relationships and to withdraw from the world (e.g., she noted that she frequently spent consecutive days in bed). Furthermore, she noted that these symptoms worsened since the death of her daughter and that this led to her current unemployment and departure from church (which was an activity she valued).

Camila explained that her depressive symptoms had been present for over 23 years but had steadily increased since the sudden unexpected death of her daughter 3 years ago. Based on this information, it seemed that Camila’s current depression had been exacerbated by the death of her daughter. She also noted her depression was worse after the death of her brother. Thus, it seemed that Camila’s depression had followed a chronic course, and that the severity of her depression waxed and waned as a function of specific life stressors.

Camila reported she had a good romantic relationship with her current partner who provided emotional support. She stated that her only dissatisfaction with the relationship was that she did not see him very often (about once a month). In terms of friendships, Camila noted having a few good friends from church. However, she stated that she did not interact with them regularly. Camila reported that her financial situation reflected meager conditions but no physical hardships (e.g., she had enough food, a place to live, and clothes). She stated that she was not working and that she felt dissatisfied with this situation and would like to pursue a job. Camila reported having a good relationship with her children but noted that they over-involved her in their personal issues such as child rearing and marital strife. She reported that she continued to have contact with her mother and siblings but that she had a very poor and unsupportive relationship with them.

Camila attended a total of 20 therapy sessions. During the first few sessions, Camila was provided with psychoeducation on the nature of depression. More specifically, it was explained that there are links between “what you do, where you do it, how you do it, and how it makes you feel.” It was emphasized that depression is a problem between the individual and their environment rather than a problem that occurs only inside of the individual. Camila felt that this model reflected her experience with depression. The patient was encouraged to identify specific life goals that she felt were within her reach and that would make her feel satisfied (and build a foundation for empowerment). Camila stated that in her ideal world, she would go back to school, find a job, or obtain a volunteer position where she could help others. As is common among depressed individuals, Camila noted that although she would like to try to achieve these types of goals, she did not think she could.

During the first sessions, the therapist asked Camila to chronicle her daily activities. Camila found the homework assignment of writing her daily activities useful because it made her realize that she spent most of her time alone at home. Camila noted that most of the time when she was alone, she was thinking of negative life events, and this led her to become sadder. She noted that during the times that she was with others engaging in an activity, such as eating at a restaurant, she was not sad. Camila explained that her goals for therapy were to decrease her depression and to no longer feel like she was alone. She indicated that she would like to be involved with others and the community. Camila also stated that she would like to learn how to cope with the death of her daughter. She noted that she often thinks of her and becomes sad. Camila said that sometimes, thoughts of her daughter led her to withdraw from the world and that during those occasions she would remain in her bedroom for days. She stated she often cried alone when she thought of her and would like to learn how to have an alternative response to the death of her daughter.

Camila’s therapist suggested that another goal for treatment should also be discontinuing Camila’s current romantic relationship. The therapist suggested that since her partner lived in another city and had no plans of moving, the relationship could not provide the type of support Camila needed. The therapist felt that by discontinuing the relationship, Camila would be free to pursue a more supportive relationship that would alleviate her feelings of loneliness and contribute to recovery from depression.

After several sessions, Camila disclosed that she often drinks when she is alone. She reported that it started as an occasional glass of wine to just to relax, but in the past few months, the frequency of her drinking had increased. She also said that this was a contributing factor to her withdrawal from church activities, as she was worried that the church members would smell alcohol on her. She tried to stop drinking several times, but was unsuccessful due to severe headaches. However, Camila believed that she could stop drinking if she had a strong motivation, such as a job.

Questions:

(1) Please identify the strengths and risks of Camila using the ecological model and the strengths perspective. Make sure to address risks and strengths at all aspects of her environment (individual, family, community, etc.). Indicate why it is important for a social worker to identify clients` strengths and risks at the start of the therapeutic process.

(2) Based on the description provided, what were Camila’s presenting problems? Please describe the main problem(s) in detail.

a. Based on the information provided, do you believe that Camila has a problem with alcohol? Please reference the criteria for problematic substance use in your answers.

(3) Please describe the referral process for Camila explained in the case information above (i.e. self-referral for therapy, mandated referral, suggested by friends or relatives, etc.). Do you believe this specific referral process might affect her motivation and engagement in therapy? If yes, in what way?

(4) Based on the description provided above, identify goals for treatment. Please list three or four specific goals that are most relevant in your opinion. Remember to incorporate the client’s perspective when formulating treatment goals.

a. Camila’s therapist suggested that one of the goals for treatment should be discontinuing Camila’s current romantic relationship (see paragraph 10). Do you agree or disagree with the therapist’s suggestion to include this treatment goal? Please explain your answer in detail.

(5) Propose a detailed and specific intervention plan for Camila. Remember that a good intervention plan must incorporate a specific theoretical model (e.g. psychodynamic therapy, problem-solving method, cognitive-behavioral, etc.). In addition, the plan must be informed by the strengths and risks identified in question 1, as well as the specific goals for treatment identified in question 4.

Submission Guidelines:

· The assignment should be typed in font 12, double spaced, and not exceed 7 pages.

· The assignment should be written in an essay form, and include sub-headings to identify the questions answered (suggested sub-headings):

· Risks and Strengths

· Presenting Problems

· Referral Process

· Treatment Goals

· Intervention Plan

· This assignment should be written as a formal paper. Do not use slang or conversational/colloquial language. The use of “I” should also be avoided. Please utilize the campus Center for Writing Excellence if you need assistance.

· The textbook must also be utilized and appropriately referenced and cited within the assignment. References to outside articles and readings are optional. MLA or APA format is acceptable.

· Submission due date is 11/20/18, at 11:59pm. Late submissions will not be accepted, with the exception of emergencies approved in advance by the instructor.