Case : Susanna
Susanna is a 24-year-old Caucasian female. She’s coming to see you because she reports having anxiety attacks that do not allow her to eat, a lack of sleep, consistently crying at work as well as home. She is one of three children. She is the eldest of the three 24, 22, and has a 16-year-old brother. She is from a large Jewish family, and she has been dating the same boyfriend, Anthony, since freshman year in high school. Because of that boyfriend, she came home every weekend during college, as did he. She never joined a sorority. She never participated in any activities on campus because she always just wanted to get back and spend time with her boyfriend. So although she lived away for four years, she really never left home. In fact, while you’re talking to her, she is still living in her parent’s house. Her sister has moved out, but her brother is still at home.
Susanna is a grade school teacher. She teaches third grade. She did her student teaching at the same school she went to elementary school, and they offered her a job. So now the teachers that are around her, are the teachers she had when she was in grade school and that comforts her. Her grade school was only two miles from her house. She and her boyfriend have recently become engaged, and there’s a huge wedding planned where there will be over 500 guests at a very formal black-tie event. Susanna’s been waiting for this marriage all of her life. She has dreamed about having a huge wedding, but now as it comes closer and closer she’s having a lot more panic attacks and a lot more anxiety about the wedding.
She has lost so much weight that they’ve had to do two different significant alterations on her dress. She’s yelling at her boyfriend because he’s not helping with the wedding as much as she thought he should. Helping stuff envelopes for the invitations, actively choosing food cake and DJ. and so they have fights about this. She and her fiance Anthony, have bought a condo. The condo is half a mile from her work and four miles from her mother’s house. She will not go there to sleep until she and Anthony have moved in there together. That’s going to happen about two weeks before the wedding. Again, she reports some fears about being alone. The fears are keeping her up at night because she’s anxious that when she gets married it’s going to be worse because her fiancé has a traveling job where he’s gone two nights of the week to cover his territory for sales.
When you talk to Susanna for the first time, you find her to be very easygoing but very, very difficult to talk to because she’s speaking at hyper speed. She said that this becomes problematic with her when she’s in her classroom teaching the third graders. She can tell that she loses the third graders interests and she’s afraid that she’s going to loose her job when they start new teacher observations, she’s afraid that even though they know her well and they invited her to come work there, that they’re going to find her not to be worthy.
So as we go along there was much confusion about what’s going on with Susanna. She continues to go out with her fiancé. She continues to socialize with her family. She and her mother are planning the wedding. There have been several bridal showers for her. There’s been a bachelorette party planned with her and her girlfriends, and she goes to all these events, but she can’t relax. She can’t get comfortable, and she can’t eat. As we talk further and further, we find that what’s really going on for her is that she is struggling with being the center of attention with 500 people at the wedding. So we started doing some deep breathing exercises, some meditation, some journaling, and even some yoga. This seems to be calming her down a lot, but she’s apprehensive about the day of the wedding. You have agreed to will attend the wedding in case there’s a panic attack.
So this is a boundary issue here that we need to talk about, and that’s why I’m putting this case up for discussion. We shouldn’t have dual relationships with our clients. So attending a wedding where there are family and friends and that you don’t know anybody else, is awkward. You’re really there for the benefit of the client, and there is purpose to it, but it feels very uncomfortable to you. In your supervision, you talk it over with your supervisor, and she agrees that it is odd, but she also says it’s probably vital to the client to have you thereon a just in case basis. So you reluctantly agree to go to the wedding. You sit through the service, and you watch her walk down the aisle after she walks down the service is over. You wait until she comes back out to join the reception. You see, her mother and her mother say that she’s doing fine and so you’re able to leave. You see Susanna for a few more sessions after the wedding, and she seems to have calmed down immensely. She reports having a great time at her wedding and reports how helpful she found the journaling, meditation and yoga.
Chapter one of Susanna. Chapter two of Susana becomes more interesting. She and her husband got transferred to a larger territory, and she had to leave the state. She left the state. She lived for three years someplace else and then her husband was transferred back to this area to take an administrative job, vice president of sales. They were in a much larger house. Her brother had died from an overdose ofherion, and she couldn’t get the same job back, so she was doing some tutoring on the side to keep her busy, and she now also had two children.
The anxiety attacks were returning, and she didn’t understand why because she was home with her mother. She had her kids, she had her own house, she had a very nice schedule with her tutoring, but things were getting uncomfortable for her again. She returns, finds you still in practice, and we agreed to come for sessions. Here we have to figure out did she stop doing any of the activities? Did she stop doing meditation, breathing exercises, yoga journaling? And then we have to find out what the new stressor is. So your goal is to figure out what questions you’re going to ask to find out where the unique stressors are if she’s back in her old neighborhood has her children to care for, has a new house, and her husband is available (not traveling as much). So what kind of questions will you explore, and what areas do you think that this new stressor has become an issue?
Using the Case Studies provided, in 1.5-2.5 pages you will identify the following:
• What is the client’s overall issue?
• Using 1 or 2 of the psychosocial theories, analyze/explain client’ situation or behavior
• What are the client’s immediate needs? Long-term needs?
• What are the client’s strengths?
• What potential barriers can you identify that may impede client’s progress?
• What community resources can you access to assist the client?
• How will you know the issue has been resolved?
• Identify a minimum of one policy (local, state, federal, etc.) that will effect your work with this client? (I am located in New Jersey)
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