Assignment
Case Scenario
May, 37, grew up in an upper-middle class family in the suburbs. She achieved excellent grades in high school, attended college and law school in Washington, D.C. Graduating near the top of her class, May was rewarded with a position in the Washington, D.C. office of a prestigious multinational law firm. She worked long hours and seldom had time for herself.
Four years into her career May met her husband, Brian, also a successful attorney at a prestigious Washington law firm. A couple of years after getting married they decided it was time to start building a family. Along with this decision came the understanding that May would stay home to raise the children, while her husband continued working. This arrangement suited both, for a few years, until May started feeling left behind. Her husband continued climbing the ladder of success and traveling around the world, while May held the less gratifying job of tending to the children and running errands.
When the children started school full-time May discovered a glass of wine at lunch would ease her feelings of boredom and lessen the resentment that had been simmering inside of her for some time. Soon the single glass of wine at lunch turned into a second glass in the afternoon, and another while the children ate dinner. In the span of less than one year May was drinking quite frequently, taking pills, and hiding the evidence. It wasn't until May's husband received a call from the school that no one had picked up their children. Her husband rushed to the school and when he and their children got home, they found May passed out on the bed with an empty wine bottle on the nightstand. May's husband had suspected there was a problem, but the day's events removed any doubt, and he decided that action had to be taken. That evening he went online looking for solutions and through a series of phone calls was introduced to your company, Family Intervention.
Imagine you are the clinical person leading the intervention, you spoke with Brian for over an hour about his concerns and uncovered why he was reluctant to send his wife to treatment. He feared May would feel betrayed or be so angry at him their relationship would never be the same even if she stopped drinking. Having heard these concerns before you explained addiction is a brain disease, and it was very rare for someone addicted to a substance to simply stop drinking or quit using without professional help. Intervening on an addicted family member is doing what is medically necessary. You suggested that he wouldn't hesitate to get her help if she were diagnosed with another disease and that addiction is no different.
After meeting with Brian and May's family you began planning an intervention. You all agreed your approach would consist of love and kindness with strong boundaries. You all discussed consequences in the event that she refused treatment. On the afternoon of the intervention the family was prepared for what was to come. You all worked closely together discussing treatment options and answering any anticipated objections May would have. When May entered the room you, as the clinician leading the intervention, stood up and introduced yourself. You asked if she knew why her family was there that afternoon. "I suspect it has something to do with me forgetting to pick-up the kids from school," she said.
You didn't directly respond to her answer though you indicated she was correct. You told May everybody was there because they loved her and wanted her to get help for her drinking. The family read the intervention letters they prepared, and May cried during some and laughed during others. Each letter ended with a plea for her to accept help immediately. When the circle was complete, you all sat and waited for May's response. After a minute of silence, you asked her what she was thinking. May said going to residential treatment is too big of a response for not picking up the kids one time at school. Not expecting her to accept treatment without a discussion you explained that forgetting the kids at school was part of the much larger picture. When you pressed her for a more in-depth history of her drinking her demeanor began softening.
May expressed that treatment seemed like a punishment for her being an alcoholic. You pulled a colorful brochure of the treatment center from your bag for her to see. May was visibly relieved to see what appeared to be a cross between a small college campus and a summer camp. You assured her you had brought many professionals to this treatment center and that none of them ever regretted being there. It took little more discussion for May to accept treatment and overcome her fear of the unknown. Once she accepted, the feeling of relief filled the room. You arranged for her to see the children before leaving and explained to them mommy was going on a work trip and she would come home as soon as her work was done. You and the family knew addressing the children would be difficult for May, so you thought it out carefully.
May completed 30 days of residential treatment followed by 60 days of intensive outpatient treatment locally and individual therapy. She has been sober since completing treatment and attends AA meetings near her home.
Task
A. How would you define May's presenting problem?
B. What is the root cause(s) of May's presenting problem?
C. Describe at least three family risk factors for substance use in children and adolescents.
D. Research indicates that the following signs of risk can be seen as early as infancy or early childhood:
a. Aggressive behavior
b. Lack of self-control
c. Difficult temperament
d. All of the above
E. Describe the best risk factor that may be contributing to May's substance use.
F. Describe the protective factors for women that can help in May's substance use treatment.
G. Identify and list the positive aspects of May's situation.
H. Identify and list the strengths aspects of May's situation (these will be different than positives listed above, though strongly correlated).
I. Brian was reluctant to do the intervention and stated that May would feel betrayed or be so angry at him and their relationship would never be the same even if she stopped drinking. How does the concept of Homeostasis in General Systems theory help in your understanding of Brian and May's way of functioning? In other words, why might change have been challenging for them both? Your answer should explain homeostasis and how it applies to May and Brian's way of being.
J. May stated going to residential treatment was too big of a response for not picking up the kids one time at school. As the clinician, you are not expecting her to accept treatment without a discussion therefore, you explained that forgetting the kids at school was part of the much larger picture. How does General Systems theory help to explain how May's behavior impacts the entire system?