3. group home with counseling.
She refuses to return home due to the abuse she experienced.
After 3 months at Teens
First, Ella said she is thinking about reinitiating contact with
her mother. She has not
seen either parent in 6 months and missed the stability of the
way her family “used to
be,” although she is also conflicted due to recognizing the
instability of her family. Ella is
confused about the path to follow.
Family Dynamics
Ella indicates that her family worked well until her father began
drinking heavily about 3
years ago. She remembers her parents being social and going
out or having friends
over for drinks, but she never remembered them becoming
drunk. Then, her father lost
his job as an information technology (IT) support professional
and was unable to find
meaningful work. He took on part-time jobs at electronics
stores, but they left him
demoralized. Her parents stopped socializing, and then her
father was fired from his last
job because he arrived drunk. Ella’s father would regularly be
drunk by the time she
arrived home from school.
When Ella started having trouble in school, her father would
berate her when she came
home if she didn’t study immediately. Then, he would interrupt
her studies by following
her around and verbally abusing her. Soon after, he began
hitting her or throwing
objects at her. Once she went to the emergency room for
stitches on her brow when
5. father lost his job, Ella began
experiencing learning disabilities. Her difficulties began in
math, where she had difficulty
sorting and making sense of numbers. Then she began to fall
behind in her reading. Her
grades went from a B average to consistent D’s. Some of Ella’s
Instructors began to
raise the issue of a possible learning disability. A counselor
made an appointment to
discuss possible causes, but Ella left school and home just prior
to that meeting, and did
not attend.
Employment History
Ella reports that her father was employed as an IT support
professional at a bank. When
the bank downsized and closed many branches, her father was
laid off. He was unable
to secure another IT support position, as many companies had
begun outsourcing this
work to contractors or overseas. He began to work part-time
retail jobs at consumer
electronics stores but quickly became demoralized and lost a
series of those jobs. Her
mother works as a full-time home health aide.
Social History
Ella reports that the homeless encampment (where she wound
up for a long stretch)
had a group of teens that stuck together for protection and to
shield themselves and
each other from certain bad choices. It was at this time that Ella
reports she became
bisexual, seeking out and bonding to a group of women who
were able to avoid being
exploited for human trafficking.
7. Mental Health History
Ella began counseling to address the abuse in her history. In her
initial reports, as
detailed above, she cites mostly verbal and psychological abuse
with only two instances
of physical abuse. She denies any sexual abuse.
When Ella recounts the physical abuse specifically, however,
she shows added signs of
acute distress and trauma. The physical harm caused by the
event that triggered her
leaving was reportedly significant—bruising on both arms, a
split lip, a bloody nose, and
a bump on the head—all from punches—as well as bruises on
her leg from being
kicked. She did not seek medical help and avoided as much
social contact as possible
the day she ran away, so as not to encourage inquiries about her
home situation.
Ella does have positive memories of what she calls “the before
time,” and she shows a
desire to return to that time. She worries for her mom, despite
feeling betrayed by her.
The last time she did have contact with her mom, she promised
to leave her dad, but
Ella does not know if this ever occurred.
Legal History
Ella has been arrested three times, twice for shoplifting and
once for vagrancy. Citing
the abuse she reported at home and the fears she felt, Ella was
mandated to services at
the Teens First agency, unlike her prior arrests when she was
sent to detention.
9. Paula Cortez
Identifying Data
Paula Cortez is a 43-year-old Catholic Hispanic female residing
in New York City, New
York. Paula was born in Colombia. When she was 17 years old,
Paula left Colombia
and moved to New York where she met David, who later
became her husband. Paula
and David have one son, Miguel, 20 years old. They divorced
after 5 years of marriage.
Paula has a 5-year-old daughter, Maria, from a different
relationship.
Presenting Problem
Paula has multiple medical issues, and there is concern about
whether she will be able
to continue to care for her youngest child, Maria. Paula has
been overwhelmed,
especially since she again stopped taking her medication. Paula
is also concerned
about the wellness of Maria.
Family Dynamics
Paula comes from a moderately well-to-do family. Paula reports
suffering physical and
emotional abuse at the hands of both her parents, eventually
fleeing to New York to get
away from the abuse. Paula comes from an authoritarian family
where her role was to
be “seen and not heard.” Paula states that she did not feel
valued by any of her family
members and reports never receiving the attention she needed.
As a teenager, she
10. realized she felt “not good enough” in her family system, which
led to her leaving for
New York and looking for “someone to love me.” Her parents
still reside in Colombia
with Paula’s two siblings.
Paula met David when she sought to purchase drugs. They
married when Paula was 18
years old. The couple divorced after 5 years of marriage. Paula
raised Miguel, mostly by
herself, until he was 8 years old, at which time she was forced
to relinquish custody due
to her medical condition. Paula maintains a relationship with
her son, Miguel, and her
ex-husband, David. Miguel takes part in caring for his half-
sister, Maria.
Paula does believe her job as a mother is to take care of Maria
but is finding that more
and more challenging with her physical illnesses.
Employment History
Paula worked for a clothing designer, but she realized that her
true passion was
painting. She has a collection of more than 100 drawings and
paintings, many of which
track the course of her personal and emotional journey. Paula
held a full-time job for a
number of years before her health prevented her from working.
She is now unemployed
and receives Supplemental Security Disability Insurance (SSD)
and Medicaid. Miguel
does his best to help his mom but only works part time at a
local supermarket delivering
groceries.
12. called her relentlessly, and
when she did not pick up the phone, he left her mean and
threatening messages. Paula
was fearful for her safety and thought her past behavior with
drugs and sex brought on
bad relationships with men and that she did not deserve better.
After a couple of
months, Paula realized she was pregnant. Jesus stated he did not
want anything to do
with the “kid” and stopped coming over, but he continued to
contact and threaten Paula
by phone. Paula has no contact with Jesus at this point in time
due to a restraining
order.
Mental Health History
Paula was diagnosed with bipolar disorder. She experiences
periods of mania lasting
for a couple of weeks, and then goes into a depressive state for
months when not
properly medicated. Paula has a tendency toward paranoia.
Paula has a history of not
complying with her psychiatric medication treatment because
she does not like the way
it makes her feel. She often discontinues it without telling her
psychiatrist. Paula has
had multiple psychiatric hospitalizations but has remained out
of the hospital for the past
5 years. Paula accepts her bipolar diagnosis but demonstrates
limited insight into the
relationship between her symptoms and her medication.
Paula reports that when she was pregnant, she was fearful for
her safety due to the
baby’s father’s anger about the pregnancy. Jesus’ relentless
phone calls and voicemails
14. (SNF) where she thought she would die. After being in the
skilled nursing facility for
more than a year, Paula regained the ability to walk, although
she does so with a severe
limp. She also regained some function in her right arm. Her
right hand (her dominant
hand) remains semi-paralyzed and limp. Over the course of
several years, Paula taught
herself to paint with her left hand and was able to return to her
beloved art.
Paula began treatment for her HIV/AIDS with highly active
antiretroviral therapy
(HAART). Since she ran away from the family home; married
and divorced a drug user;
and then was in an abusive relationship, Paula thought she
deserved what she got in
life. She responded well to HAART and her HIV/AIDS was well
controlled. In addition to
her HIV/AIDS disease, Paula is diagnosed with Hepatitis C
(Hep C). While this condition
was controlled, it has reached a point where Paula’s doctor
recommends she begin a
new treatment. Paula also has significant circulatory problems,
which cause her severe
pain in her lower extremities. She uses prescribed narcotic pain
medication to control
her symptoms. Paula’s circulatory problems led also to chronic
ulcers on her feet that
will not heal. Treatment for her foot ulcers demands frequent
visits to a wound care
clinic. Paula’s pain paired with the foot ulcers make it difficult
for her to ambulate and
leave her home. Paula has a tendency for noncompliance with
her medical treatment.
She often disregards instructions from her doctors and resorts to
17. Identifying Data
Sam Franklin is a 41-year-old, married, African American male.
Sam’s wife, Sheri, is 41
years old. They have two sons, Miles (10) and Raymond (8).
The family resides in a
three-bedroom home in a middle-class neighborhood in
Rockville, Maryland. They have
been married for 11 years.
Presenting Problem
Sam, a war veteran, came to the Veterans Affairs Health Care
Center (VA) for services
because his wife threatened to leave him if he does not get help.
She is particularly
concerned about his drinking and lack of involvement in their
sons’ lives. She told him
his drinking is out of control and is making him mean and
distant. Sam reports he and
his wife have been fighting a lot and that he drinks to take the
edge off and help him
sleep. Sam expresses fear of losing his job and his family if he
does not get help. Sam
identifies as the primary provider for his family and believes
this is his responsibility as a
husband and father. Sam realizes he may be putting that in
jeopardy because of his
drinking. He says he has never seen Sheri so angry before, and
he sees she is at her
limit with him and his behaviors.
Family Dynamics
Sam was born in Alabama to an African American family
system. He reports his time
growing up to have been within a “normal” family system with
a large extended family in
his town and nearby towns. He states he was emotionally close
18. to his mother and
worshipped his father. His father was strict but loving, pushing
Sam to become fairly
independent from a young age. His dad had previously been in
the military and was
raised with the understanding that his duty is to support his
country. His family displayed
traditional roles, with his dad supporting the family after he was
discharged from military
service. Sam was raised to believe that real men do not show
weakness and must be
the head of the household.
Sam’s parents are deceased, and he has three older sisters who
live in Atlanta. He is
close to the sister who is close to him in age, and they talk
frequently on the phone.
Sam has not, however, shared his current struggles with any of
his siblings. He is afraid
to let them down.
Sheri is an only child, and although her mother lives in the area,
she offers little support.
Her mother never approved of Sheri marrying Sam, so she
thinks Sheri needs to deal
with their problems on her own. Sam reports he has not been
engaged with his sons at
all since his return from Iraq, and he keeps to himself when he
is at home.
Sam and Sheri met during one of his stateside deployments prior
to being deployed to
Iraq. At the time, Sheri was still in college. Sam and Sheri both
say they “fell for each
other fast” and kept in touch during Sam’s deployment to Iraq.
When Sam’s deployment
20. couple has some mutual
couple friends, since Sheri gets involved with the parents in
their sons’ school.
However, because of Sam’s recent behaviors, their socializing
with other couples has
tapered off. He is very worried that Sheri will leave him due to
the isolation.
Mental Health History
Sam reports that since retiring from the military 10 months ago,
he has difficulty
sleeping, frequent heart palpitations, and moodiness. After his
deployment, during his
stateside assignments, he reports he did not experience intense
feelings from his
experiences on the battlefield. He would occasionally have
intense memories, but he
reports that he was able to “lock them back up pretty quickly.”
It is only since his
retirement that these feelings arose.
Sam has seen Dr. Zoe, a psychiatrist at the VA, who diagnosed
him with post-traumatic
stress disorder (PTSD). Dr. Zoe prescribed Paxil to help reduce
his symptoms of
anxiety and depression, and suggested Sam also begin
counseling. Sam says he does
not really understand what PTSD is, but thinks it refers to a
person who is “going crazy.”
He admits he thought was happening to him at times.
Sam expresses concern that he will never feel “normal” again
and says that when he
drinks alcohol, his symptoms and the intensity of his emotions
ease. Sam describes that
he sometimes thinks he is back on the battlefield, which makes
22. college. Sam received a
bachelor’s degree in human resources management upon his
return from the military.
Military History
Sam is an Iraqi War veteran. He enlisted in the Marines at 18
years old. Sam was
stationed in several states prior to Sam being deployed to Iraq.
Sam left the service 10
months ago but still works in human resources as a civilian.
Medical History
Sam is physically fit but an injury he sustained in combat
sometimes limits his ability to
use his left hand. Sam reports sometimes feeling inadequate
because of the reduction
in the use of his hand, but he tries to push through because he
worries how the injury
will impact his responsibilities as a provider, husband, and
father. Sam considers
himself resilient enough to overcome this disadvantage and “be
able to do the things I
need to do.” Sheri is in good physical condition and has
recently found out that she is
pregnant with their third child.
Legal History
Sam and Sheri deny having criminal histories.
Alcohol and Drug Use History
As teenagers, Sam and Sheri used marijuana and drank. Both
deny current use of
marijuana but report they still drink. Sheri drinks socially and
has one or two drinks over
the weekend. Sam reports that he has four to five drinks in the
evenings during the
24. Presenting Problem
Helen reports feeling overwhelmed and “blue.” She was referred
by a close friend who
thought Helen would benefit from having a person who would
listen. Although she is
uncomfortable talking about her life with a stranger, Helen says
that she decided to
come for therapy because she worries about burdening friends
with her troubles. John
has been expressing his displeasure with meals at home, as
Helen has been cooking
less often and brings home takeout. Helen thinks she is
inadequate as a wife. She
states that she feels defeated; she describes an incident in which
her son, Alec,
expressed disappointment in her because she could not provide
him with clean laundry.
Helen reports feeling overwhelmed by her responsibilities and
believes she can’t handle
being a wife, mother, and caretaker any longer.
Family Dynamics
Helen describes her marriage as typical of a traditional Greek
family. John, the
breadwinner in the family, is successful in the souvenir shop in
town. Helen voices a
great deal of pride in her children. Dmitra is described as smart,
beautiful, and
hardworking. Althima is described as adorable and reliable.
Helen shops, cooks, and
cleans for the family, and John sees to yard care and
maintaining the family’s cars.
Helen believes the children are too busy to be expected to help
around the house,
knowing that is her role as wife and mother. John and Helen
26. Helen spoke to her husband, John (the family decision maker),
and they agreed to have
Alec (their son) move in with Magda (his grandmother) to help
relieve Helen’s burden
and stress. John decided to pay Alec the money typically given
to Magda’s helper. This
has not decreased the burden on Helen, since she had to be at
the apartment at least
once daily to intervene with emergencies that Alec is unable to
manage independently.
Helen’s anxiety has increased, since she noted some of Magda’s
medications were
missing, the cash box was empty, Magda’s checkbook had
missing checks, and jewelry
from Greece, which had been in the family for generations, was
also gone.
Helen comes from a close-knit Greek Orthodox family, where
women are responsible
for maintaining the family system and making life easier for
their husbands and children.
She was raised in the community where she currently resides.
Both her parents were
born in Greece and came to the United States after their
marriage to start a family and
give them a better life. Helen has a younger brother and a
younger sister. She was
responsible for raising her siblings, since both her parents
worked in a fishery they
owned. Helen feared her parents’ disappointment if she did not
help raise her siblings.
Helen was very attached to her parents and still mourns their
loss. She idolized her
mother and empathized with the struggles her mother endured
27. raising her own family.
Helen reports having that same fear of disappointment with her
husband and children.
Employment History
Helen has worked part time at a hospital in the billing
department since graduating from
high school. John Petrakis owns a Greek souvenir shop in town
and earns the larger
portion of the family income. Alec is currently unemployed,
which Helen attributes to the
poor economy. Dmitra works as a sales consultant for a major
department store in the
mall. Althima is an honors student at a local college and earns
spending money as a
hostess in a family friend’s restaurant. During town events,
Dmitra and Althima help in
the souvenir shop when they can.
Social History
The Petrakis family live in a community centered on the
activities of the Greek Orthodox
Church. Helen has used her faith to help her through the more
difficult challenges of not
believing she is performing her “job” as a wife and mother.
Helen reports that her
children are religious but do not regularly go to church because
they are very busy.
Helen has stopped going shopping and out to eat with friends
because she can no
longer find the time since she became a caretaker for Magda.
Mental Health History
Helen consistently appears well groomed. She speaks clearly
and in moderate tones
and seems to have linear thought progression—her memory
29. ready to begin her day. She says she has trouble staying asleep,
waking two to four
times each night, and she feels tired during the day. Working is
hard because she is
more forgetful than she has ever been. Helen says that she feels
like her body is one
big tired knot.
Legal History
The only member of the Petrakis family that has legal
involvement is Alec. He was
arrested about 2 years ago for possession of marijuana. He was
required to attend an
inpatient rehabilitation program (which he completed) and was
sentenced to 2 years’
probation. Helen was devastated, believing John would be
disappointed in her for not
raising Alec properly.
Alcohol and Drug Use History
Helen has no history of drug use and only drinks at community
celebrations. Alec has
struggled with drugs and alcohol since he was a teen. Helen
wants to believe Alec is
maintaining his sobriety and gives him the benefit of the doubt.
Alec is currently on 2
years’ probation for possession and has recently completed an
inpatient rehabilitation
program. Helen feels responsible for his addiction and wonders
what she did wrong as
a mother.
Strengths
Helen has a high school diploma and has been successful at
raising her family. She has
developed a social support system, not only in the community