Case study assignment
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clientinformation.docxCLIENT INFORMATION
Janet called the mental health center to ask if someone could help her five-year-old son, Adam. He had been having trouble sleeping for the past several weeks, and Janet was becoming concerned about his health. Adam refused to go to sleep at his regular bedtime and also woke up at irregular intervals throughout the night. Whenever he woke up, Adam would come downstairs to be with Janet. Her initial reaction had been sympathetic; she would give him some water, talk to him, and rock him back to sleep. As the cycle came to repeat itself night after night, Janet’s tolerance grew thin and she became more belligerent. She found herself engaged in repeated battles that usually ended when she agreed to let him sleep in her room. Janet felt guilty about giving in to a five-year-old’s demands, but it seemed like the only way they would ever get any sleep. The family physician was unable to identify a physical explanation for Adam’s problem; he suggested that Janet contact a psychologist. This advice led Janet to inquire about the mental health center’s series of parent training groups.
Applicants for the groups were routinely screened during an individual intake interview. The therapist began by asking several questions about Janet and her family. Janet was 30 years old and had been divorced from her husband, David, for a little more than one year. Adam was the youngest of Janet’s three children; Jennifer was 10 and Claire was 8. Janet had resumed her college education on a part-time basis when Adam was 2 years old. She had hoped to finish her bachelor’s degree at the end of the next semester and enter law school in the fall. Unfortunately, she had withdrawn from classes one month prior to her appointment at the mental health center. Her current plans were indefinite. She spent almost all of her time at home with Adam.
Janet and the children lived in a large, comfortable house that she had received as part of the divorce settlement. Finances were a major concern to Janet, but she managed to make ends meet through the combination of student loans, a grant-in-aid from the university, and child-support payments from David. David lived in a nearby town with a younger woman whom he had married shortly after the divorce. He visited Janet and the children once or twice every month and took the children to spend weekends with him once a month.
Having collected the necessary background information, the therapist asked for a description of the circumstances surrounding the development of Adam’s sleep difficulties and the factors that currently affected the problem. This discussion covered the sequence of a typical evenings’ events, beginning with dinner and progressing through the following morning. It was clear during this discussion that Janet felt completely overwhelmed by the situation. She was exasperated and felt that she was completely unable to control her son. At several points during the interview, Janet seemed to be on the verge of tears. Her eyes were watery, and her voice broke as she discussed her response to David’s occasional visits. The therapist, therefore, suggested that they put off a further analysis of Adam’s problems and spend some time discussing Janet’s situation in a broader perspective.
In the subsequent conversation, it became clear that Janet’s mood had been affected since her husband had asked for a divorce. She felt sad, discouraged and lonely. The feelings seemed to become even more intense just prior to her withdrawal from the university (one year after David’s departure). When David left, she remembered feeling “down in the dumps,” but she could usually cheer herself up by playing with the children or going for a walk. But with the beginning of Adams’s sleep problem, she was nearing desperation. She now cried frequently and for long periods of time. She lost interest in her friends, and the children now seemed to be more of a burden.
Janet appeared preoccupied by her divorce from David and admitted that she spent hours each day brooding about the events that led to their separation. These thoughts interfered considerably with her ability to concentrate and seemed directly related to her withdrawal from the university. She found that she was totally unable to study or concentrate on a lecture. Withdrawing from school had precipitated further problems. She was no longer eligible for student aid and would have to begin paying back her loans within a few months. One worry led to another and her attitude became increasingly pessimistic. Janet harbored considerable resentment toward David and his new wife, although she blamed herself for the divorce, saying that she had acted selfishly by returning to school and placing a new financial burden on the marriage. She also generalized from her marriage to other relationships in her life. If her first marriage had failed, how could she ever expect to develop a satisfactory relationship with another man? Furthermore, Janet had begun to question her value as a friend and a parent. The collapse of her marriage seemed to affect the manner in which she viewed all of her social relationships.
The future looked bleak from her current perspective, but she had not given up all hope. Her interest in solving Adam’s problem, for example, was an encouraging sign. Although she was not optimistic about the chances of success, she was willing to try to develop new skills that would help her become a more effective parent.
SOCIAL HISTORY
Janet’s early childhood had been uneventful. An only child, she spent most of her time with adults, particularly her mother. She remembered her parents’ relationship as being warm and pleasant with frequent family outings.
When Janet was 13 years old, her mother died in an automobile accident. The following months were very difficult for Janet and her father. Her father was overcome with grief but managed to continue working and arranged for neighborhood friends to care for Janet. Janet was generally able to continue her normal activities, and her performance at school was not markedly affected. She was able to maintain her small circle of friends. She did remember spending long hours in her mother’s room, trying on her mother’s clothes, looking at old photographs and crying softly. Her father’s response appeared to be sympathetic and appropriate.
Even prior to her mother’s death, Janet had been reserved socially. She tended to have one or two special friends with whom she spent much of her time outside of school, but she felt awkward and self-conscious in larger groups of children. Although her friends were important to her and she enjoyed spending time with them, Janet usually waited for friends to contact her. She did not initiate activities and hesitated to express her own preferences when they were trying to decide what to do. In retrospect, Janet attributed this lack of assertion to her fear that her friends would abandon her or ridicule her interests. She was also self-conscious about her weight. She was not really fat, but she tended to be a bit plump and was therefore afraid that others would tease her if she drew attention to herself.
This friendship pattern persisted throughout high school and into her college years. Janet dated intermittently until her junior year in high school, when she began to date one boy on a regular basis. Janet was sure that she was in love and expected the relationship to ultimately result in marriage. Janet and her boyfriend, John, spent all their time together, and she soon lost contact with the few girlfriends with whom she had been close.
When Adam (her third child) was two years old and able to attend a child-care center, Janet decided to resume her college education. She and David had discussed her wish to pursue a career on various occasions, but David was less than excited about her wishes. He preferred that the situation remain the same; however, he finally agreed to step up and assume a more active role with the children and responsibilities around the home. Janet began taking two classes per semester.
Subsequently, the relationship with David became increasingly strained. They had less time together, and David found it difficult to adjust to his increased household responsibilities. Instead of working to improve their communications, they bickered continuously. They found it impossible to negotiate a mutually acceptable exchange of responsibilities. The final blow came when David met another woman. He asked for a divorce and moved to an apartment.
Janet was shaken by David’s departure, in spite of the fact that they had not been happy together. Fortunately, Janet did have a few friends to whom she could turn for support. They were all very helpful for the first few weeks, but she quickly lost contact with them.
For a few months, Janet was able to continue her studies. With the children’s help, she managed the household chores and kept up with her schoolwork. After two disastrous blind dates, Janet discontinued the minimal efforts she had made to develop new friendships. She just did not know how to initiate or maintain a conversation with her classmates.
As time passed, Janet found herself brooding more and more about the divorce. She was gaining weight at the rate of three or four pounds a month. Soon her clothes no longer fit, and the children began to comment on her appearance. With the disruptions of being a single mother, Janet finally realized that she would have to withdraw from her classes to avoid receiving failing grades. Janet lost interest in her previous activities, even reading became a tedious chore. She had never had hobbies due to time constraints, and now that she had time, she had difficulty focusing her depleted energies.
This was Janet’s situation when she contacted the mental health center regarding Adams’s sleep issues. Her mood was low and pessimistic. She was preoccupied with financial concerns and her lack of social relationships. Adam’s sleep problem was the last straw. She felt unable to cope with the seemingly growing family and financial problems.
