Problem:
To Prepare:
Review the Learning Resources, particularly the Perry and Winfrey chapter.
Reflect on relational connectedness, and the environmental and contextual factors that may affect it, including cell phone and technology use, socioeconomic status and caregiver availability, and access to resources. Need Assignment Help?
Consider the factors affecting the relationships of Mel in the Case Study below.
Questions:
- Analyze how the following factors could positively or negatively affect relational connectedness:
- Cell phone and technology use
- Socioeconomic status and caregiver availability
- Access to resources
- Analyze the extent to which these factors (or others) apply to Mel's Case
Case Study:
Mel is a 40-year-old Caucasian female who is seeking therapeutic services from the community mental health center at which you are employed. Upon intake, Mel reports that she is currently homeless and has been mandated by the Department of Children's Services (DCS) to receive outpatient treatment for her issue with substance abuse. Mel further reports it is her substance use that led to the removal of her 12-month-old child, Hollie, who is currently in the custody of the state and in the home of foster parents. Per Mel's report, Hollie was born with a positive screen for amphetamines and was immediately placed in foster care. Mel states she has struggled with both methamphetamine use and homelessness over the past 5 years. Though she has family in the same city, Mel reports she has chosen to remain homeless and states, "My folks are old school and once they realized I was pregnant by someone I wasn't married to, that was it. And they don't know about me using." Mel reports that her current partner (Lance, who is Hollie's father) is also homeless. In addition, Lance has been ordered by DCS to have no contact with Hollie due to his history of violence and incarceration for possession of methamphetamine with the intent to distribute. Prior to her becoming homeless 5 years ago, Mel was working in the business administration field. Mel has her Master's in Business Administration (MBA) and maintained consistent employment in a high-paying job for several years. Mel reports she was married to her husband of 15 years when he left the relationship 6 years ago, stating that he "wanted to be with someone that could give him children." Mel reports they experienced 11 miscarriages with one being at 6 months of pregnancy. She has not previously sought therapy and notes, "It doesn't seem like it would help me. I finally had a baby-and then I lost it. What else matters?"
Homelessness
During the initial session, Mel presents with flat affect, low energy, and identifies as being sad most of the time. Mel denies a dependence on substances and insists that her use of meth has been "sporadic, to deal with all the crazies on the street." When asked what it was like for her to live pregnant and homeless, Mel became annoyed and stated, "Well, the baby was fine, right?" Mel was living in a tent during her pregnancy until local police tore down the encampment. As her due date became closer, Mel's parents insisted she come to their home because, in her words, "they didn't want to look bad having a grandchild in a tent."
Mel's Parents
Mel describes her parents as "very religious" and notes they ascribe to highly religious values. When she and her now ex-husband were experiencing miscarriages, her parents offered platitudes such as "at least you know you can get pregnant." Such statements often left Mel feeling alone and angry because they minimized how difficult the experience of losing so many pregnancies was for her. Mel states, "I shouldn't have expected it to be any different. They have always been that way when it comes to things that are hard."
Mel's Sister
Mel reports she has one sibling, an older sister who is "the golden child. They worshipped the ground she walked on. Didn't matter what I did. I was always in her shadow and was never good enough to live up to her." Mel reports she and her sister fought often with some fights leading to physical altercations. Mel states, "Didn't matter who started it, my parents always punished me and told me to try not to aggravate my sister so she wouldn't get upset."
Childhood Trauma
Mel reports her father drank most nights, and she witnessed several instances of domestic violence between her father and mother. When she was 10 years old, Mel's father was arrested for a DUI and then served 5 years in jail. Mel reports they had limited support from other family members or the community because "what happened at our house, stayed at our house. We were not to talk about it with anyone." Mel reports that school became her safe place and she always excelled there because "I could shut everything out and just learn things. That made me feel good."
Fear
Mel reports she experiences occasional nightmares about her tent being torn down by the police while she was homeless. She states that she feels as though she is constantly looking over her shoulder, on the lookout for the next bad thing that might happen. She states, "The longer I am at my parents' house, the harder it is for me to keep my head on straight."
Social Supports
Outside of the father of her baby, Mel denies any social supports. She notes the case manager from DCS is kind to her when they interact; however, Mel reports that the case manager refers to Hollie by the name the foster/adoptive parents want her to have, "Dawn." Mel becomes very agitated when she discusses the child's name, as Hollie is a name she always planned to give her daughter. Mel has one supervised visit per week with Hollie with the condition that she has a negative urine drug screen. With regard to engaging in therapy services, Mel notes she is "only here for the permanency plan. I don't have any of that other mental health stuff." When you reflect back to her that she appears anxious and restless throughout the intake, she states, "Wouldn't you be? You get to decide if I get my kid back." Mel consents to you contacting her parents for collateral information. When you contact them via telephone and ask what they are willing to do to support their daughter, they state, "Pray for her and allow her to stay in our basement. Otherwise, she is on her own." When asked what "on her own" means, her parents further state, "She's gotta figure out how to get to where she needs to be for her appointments. We aren't driving her around town. She got herself into this mess and needs to figure out how to fix it. She brought shame to our family. It's up to her to make it right."
Transportation and Employment
Mel does not currently have a driver's license as it was suspended for 5 years when she received the DUI approximately 4 years ago. Mel reports she is stressed about figuring out transportation to her place of employment and also about the type of employment she has been able to secure. Mel refers to the child abuse and neglect charge she received due to Hollie being positive for substances upon her birth. "Folks don't want to hire me when they find that on my background screen. They don't even bother asking me what happened; they just judge me and say they aren't hiring me." Mel reports she is currently employed in food service and also cleans houses. Mel reports concern that she has not worked in the business field in some time and that her MBA is now "worthless" since "I won't be able to get a job that I am capable of doing and that would pay me better so I can take care of Hollie." Mel reports that her parents refuse to give her rides to work and to visits with Hollie. Mel mostly relies on Hollie's father for transportation but cannot ask him to take her to and from her visits as he is ordered to have no contact with Hollie. Because of this, Mel relies on the bus line for her weekly visits with Hollie and states, "Don't get me wrong. I love visiting Hollie. But I have to take the entire day off on Wednesday because the bus takes the entire day." Mel also states that she feels stressed from the number of hours she cannot work due to participating in court-ordered outpatient treatment for substance-using behaviors 3 mornings each week.