Read the story answer the 3 questions i need paper to be 5-7 pages

The Case of David

David, 25 years of age, applied to the North Miami Counseling Clinic after hearing about their sliding-scale psychotherapy program for people  involved in the performing arts.   At intake, this Cuban American male reported  that he had been under pressure  by his partner  to "get  his life together"  by seeking  psychotherapy services. The  patient,  however,  could  not  afford  seeing  a private practice practitioner.   The clinician at the counseling  clinic reported that David presented in an anxious  manner and appeared  internally  preoccupied.    The clinician  also noted that  David  was  tangential  in the way  in which  he spoke about his presenting problem.

David reports that he "can't function  at a level that pleases  him and lives in a fantasy  world."   He often  feels disconnected from life and his immediate  surroundings. David states that he often struggles with feelings of worthlessness,  low  self-esteem,  apprehensiveness  and depression.   He can  easily  become  verbally  abusive  and violent with family and friends.  At times, David states that he often  experiences fear  of  leaving  his home,  and  as a result has been dismissed from a number of jobs.  David is very concerned with his appearance stating  that he is frightened with the idea of becoming overweight; therefore, he exercises on a daily basis and is overly conscious  about this daily caloric intake.

David's ultimate  career  goal  is to become  a soap opera actor.   He has had a few small parts in Spanish  soap operas,  which are often filmed  in Miami  by Mexican  and South American producers.  At auditions, however, producers have told David that he will never truly succeed as an actor and should consider  a different  type of career. He  refuses  to  accept  the  appraisal   of  his  acting  ability stating that he is convinced that one day he will become "a well-known soap opera star."  David is presently employed as a part-time manager in a South Miami Beach physical fitness center. David's housing situation is unstable, as he appears to drift from one's  friend's  apartment  to another.   He states that making consistent  rental payments  on an apartment  is difficult for him because he spends most of his earnings  on clothes   and  male  skin  products.   On  several   occasions, David's father  has grudgingly  bailed  him out financially. David  believes, however, that  his father  helps  out financially  as a way of preventing  him from ever returning back  home.    The  patient  presently   lives  with  his  male partner, Paul, a high school teacher whom he met several months ago at a local gym.

David  wishes that he could totally be dependent  on Paul, but his partner apparently cannot stand the patient's smothering dependence and resents it.    The patient describes  adjusting  poorly   both   to  his  sexuality  and capacity  for intimacy.   He describes  feeling  little pleasure in his sexual  encounters;  generally  feeling  sexually  used and then "discarded  like an old rag."

David   was  raised   in  Miami   by  his  parents   and paternal grandmother.   The family emigrated from Cuba to Miami in the 1960's fleeing  Fidel Castro's oppressive political regime. David's history  reveals  a very unstable  childhood and adolescence.  He describes his father  as a rigid, domineering and controlling  man who vacillated  between being an overprotective and punitive parent.  David felt valued by his father only when he was able for fulfill his father's wishes.  David described his mother as a "sweet" and "extremely shy" woman.  His parents' marriage reveals a history of chronic discord with frequent verbal abuse and occasional physical threats.   David claims that his father was unfaithful to his mother.  He recalls seeing his father with numerous partners over the years.  As a child and adolescent, the patient remembers worrying about who would take care of him and where would he live  if his father ever abandoned the home for another woman.  David also recalled how his mother would often retreat to the bedroom for days following any serious confrontation with the father.   The patient states  that during his childhood years he felt extremely close to his paternal grandmother who was always present irrespective of the level of chaos that may have been present in the home.

David is the second of three male children.   He remembers his older brother as volatile and extremely demanding when they were children.   The patient was fearful of the older brother and worried often because of the demands  that  this  sibling  would  place  on  the  parents.

David describes himself as being passive, not making any demands, and subsequently receiving very little attention from his parents.  The patient remembers with sadness the birth of his younger  brother  when he was four.    David states that his younger brother's birth made him feel abandoned and displaced; therefore, he would often hit and scratch himself as revenge against his parents.  His fantasy life has been a source of comfort during significant moments of emotional stress.   When the patient feels inadequate,  confused and alone  by his circumstances  he finds tension-reduction in fantasies of future success as a soap opera actor.

Upon graduating from high school, David attended a local university where he hoped to major in drama and the performing arts.  During his first semester of college courses, however, he began to feel out-of-body experiences and he recalls feeling completely  disconnected from himself.    The  patient  began  to  experience  fear  at  the thought of commuting from his home to the university campus on a daily basis.  Irrespective of this overwhelming fear, the patient managed to pass all of his first semester courses while developing a few significant friendships with

fellow freshman students.  By the end of the second semester, however, David was no longer connected to his university friends and failed three of his four courses.   The patient  was placed  on academic probation and was encouraged  by a freshman advisor to consider an academic leave from his studies.  During this time, David began to experience symptoms of anxiety, poor concentration  and an inability  to relate to people around  him.  He believed  that people  in his neighborhood  were  making  fun of him and were envious of his determination  to become a renowned Spanish  soap  opera  actor.   Due  to the  intensification  of these   symptoms,  the  patient   was  admitted   to  a  local inpatient  psychiatric  hospital unit for one month where  he was primarily  treated  with  medication.    Although  David was extremely concerned that he would become overweight as a result  of the side effects  of the  medication,  he does recall that his symptoms  ameliorated  rapidly as a result of this type of intervention.

Six months  post-hospital  discharge,  David enrolled at a local community college, believing that he was well enough to pursue  his studies in drama and the performing arts.  He continued to have problems with his concentration

and once  again  started  to believe  that his fellow  students were  envious  of  him  because   of  his  acting   potential. Feelings of confusion and anxiety exacerbated  to the point that  the  patient required a second psychiatric hospitalization.   David's  symptoms once again improved as a result of this second hospitalization, but it seems that he was  discharged  from  the  hospital   without   a  solidified follow-up  outpatient  plan.  At discharge,  the patient  opted not  to  continue his  college   studies  and  began  to  work (usually  on a part-time  basis)  while  actively  pursuing  an acting opportunity.

David's partner is not aware the he has had two previous psychiatric hospitalizations.   The patient fears that his partner will abandon him if he is honest with him about his past.   David  is seeking  psychotherapy  services  at this point in his life because he is worried that he may "lose control", and  he  is  mortified  at  the  idea  of  losing   his partner. David  presents as a very frightened and discouraged man.

Using the case of David, discuss the following issues: 

l. How does minority stress model affect our understanding of David. 

2. How   does  ideas surrounding intersectionality help us to better understand David?  

3. What are some of the risk and promotive factors that we need to take into account in our work with David.