Case Study: Ramona and Her Family
Ramona is a 17-year-old Caucasian female. After an argument with her parents, she impulsively left her home and drove to her friend's house 1,100 miles away. Without calling her friend, she showed up at a friend's house and asked if she could stay with her because she had ran away from home. Although Ramona had not seen her friend in 2 years or planned the visit, her friend allowed her to stay for a few days. Ramona appeared disheveled as if she had not bathe or slept for days. Her friend was concerned why Ramona ran away from home and because of her appearance.
Ramona told her friend she ran away from home because her parents didn't understand her. Ramona disclosed she no longer needs sleep; rather she stays awake for days, and this has caused a problem with her father. When she stays up for lengthy periods of time, she leaves home and hangs around a liquor store to meet older men who will buy her alcohol since she is underage and cannot buy alcohol herself. In exchange, the men usually are friendly with Ramona, and they drink together and eventually have sex. Her father found out that Ramona had been drinking alcohol and punished her.
Ramona told her friend that she binges for 4 or 5 days and "parties" without sleep, then feels sad for days or even weeks at a time. During these down times, she becomes reclusive, does not eat, feels unhappy, confused, disorientated, tired, and has no interest in anyone or anything. She disclosed she has thought about suicide when she is "down," and she has cut her arms and legs with her fingernails to help make her "feel better."
Ramona lives in an intact family system with her father and mother. Ramona had a normal childhood until she was 6 years old, which is when her father returned home from war. Her father is a veteran of the Marine Corps. Her father was discharged from the military due to the physical trauma he endured from a gunshot wound and the diagnosis of post-traumatic stress disorder (PTSD). Upon returning home, he began to experience distress, had violent outbursts and flashbacks, and would not show affection to Ramona. He managed his distress by drinking excessively and "blacking out." He has never received formal treatment for PTSD.
The relationship between Ramona and her father has been strained for years. Her father would yell and threaten Ramona over minor behavioral problems, belittle her when crying due to her father yelling at her, and has on occasion locked her in her room for days for behavior he deemed annoying. While these events occurred, Ramona's mother focused most of her attention on her father to manage his symptoms and drinking. Throughout Ramona's early development, her social and emotional needs were neglected, and this compromised her normal cognitive, emotional, psychological, and social development. Ramona grew up feeling ignored and believing she was annoying and worthless.
Ramona returned home after a few days of staying with her friend. She is currently living with her parents and is continuing to drink excessively and experiencing mental health issues. She plans to run away again because she believes her parents do not understand her.
Q1. Discuss Ramona's family relationships, social relationships, and emotional relationships.
Q2. Identify the risk factors that Ramona has experienced over her lifetime.
Q3. Identify the mental health symptoms Ramona is presenting and identify the mental health disorder she may be experiencing.
Q4. What are some of the behavioral problems affecting Ramona and her family negatively?
Q5. Identify two best practices in clinical interventions for Ramona and her family.
Q6. What specific family therapy model(s) would best fit this family's needs? Explain why.