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Student ID: 004039291 Bio-Psycho-Social and Plan of Change SW 3020 4/14/2013

Presenting Problem Rose Smith (pseudonym) is a 21 year old, single, Caucasian female. Although Rose has never been married, she was engaged for over a year and a half. Currently she is living with her mother and younger brother after moving out of her ex-fiances home. Rose has been working in retail for the last four years, in a managing role for the last year. Rose came to see a social worker because she is in the early stages of pregnancy and is feeling out of control and in need of help. She is also dealing with her very recent breakup and living with her brother and mother again after living separately for over three years. Family of Origin History Rose was born to Patty Westin (pseudonym) and Andrew Smith (pseudonym) when they were young. Patty was nineteen, and Andrew was 23. At the time, both were in school to better their lives (Patty for nursing, and Andrew for business), and the accidental pregnancy resulted from a few casual dates. Her mother decided to become a medical tech. instead of finishing her degree in nursing, and was able to finish the requirements before she had Rose. After the baby was born, her mother returned to work a week later and Rose was mostly taken care of by her grandmother and sometimes her aunt on her mothers side. Her parents married six months after her birth, and her younger brother was born when she was three. Rose considers her childhood to have been tense, and stated that her father was physically abusive to her mother, but never in front

3 of the children. She stated that he also never raised his hands to the children. Rose believes that her mother resents her, and wishes she were never born. She knows that her mother wished she had finished nursing school, which is something her mother has mentioned during fights over the years. Her parents split up when Rose was 11. Later Rose learned that her father had been cheating on her mother the entire time they were married. Her father remarried twice after and is newly engaged. He has two other children with his most recently divorced wife. Her younger brother, James (pseudonym), is prone to outbursts and violence. He has threatened both his mother and friends on multiple occasions, but Rose does not believe he would ever actually hurt her or her mother. He is also on his way to becoming an alcoholic, and has struggled with staying in AA. Rose stated that James gets all the attention, and that she thinks he only acts out because he wants the focus on him. When it was time for the holidays, Rose said the quality of the holiday depended on who was at the holiday, and who was drinking. Rosies family celebrated Thanksgiving, Christmas, Easter and birthdays. The most important holidays for her family though, were Thanksgiving and Christmas. For thanksgiving, Roses mothers family got together. The entire family would eat, watch football, and play poker. Christmas Eve was spent with her mothers family as well. It followed the same format as Thanksgiving, but without the football. Presents were exchanged, but the presents were small and inexpensive. Rose spent time with her fathers family for Easter and Christmas day. The celebrations were not joyful occasions, she notes. There was always a formal dinner, followed by quiet conversations and gifts that were multi-function and non-personal. If no-one was drinking, holidays were pleasant if not wonderful. However, if her father was drinking, there were many insults

4 and embarrassing statements that he made about Rose and her mother. When Rose turned 13 her grandparents on her fathers side decided they wanted no part of her mother, brother and herself. They stopped sending cards and coming to school events. After her parents got divorced and her grandparents disowned her, she says that she no longer went to celebrate Christmas or Easter with her dads family. She never saw them after they disowned her. When she was thirteen and a half her uncle committed suicide. That was the first death in her family and she didnt believe the death was handled well. Rose found out about his suicide when the phone rang at 3am, and she heard her mother crying. She was told that her uncle had died, but that was it. She did not learn that it was a suicide until after the funeral. The fact that it was a suicide was kept quiet, as it was considered too personal to talk about. She was sad about his death, but there was a part of her that was jealous that he no longer had to deal with the family and was free from the drama and pressure. There was very little talk about her uncle as a person, at least not until well after the funeral. This included good things and bad things (stories, faults, strengths, etc). Any discussion about the death of the family was about the appearance of everyone at the funeral, not on how to process the death or how anyone was feeling.

Developmental History Rose was delivered a month early. She was breech, and had to be delivered by a c-section. Other than the c-section, there were no more complications with the delivery. She was formula fed until she was two. Her mother didnt want her to be dependent on breast milk, as she was returning to work right away. She is not under the impression that there were any developmental issues. When asked for detail, Rose stated that she knew

5 very little about her infancy. Whenever she used to ask her mother about it, she was told that it was an improper conversation and that she didnt need to worry about it because she was fine.

Health History At the time of her birth, Rose was healthy as far as she was aware. The client reports no major illnesses during her childhood. When she was five she broke her arm when learning how to ride a bike. Her father was supposed to be watching her and she fell at the bottom of the driveway. The broken arm required surgery, but there were no other surgeries. Rose struggled with what she believes was an eating disorder (she believes anorexia) but was never treated as she tried to keep it from her family, and never received help. Her eating returned to a healthy level when her relationship became serious with her fianc. High-blood pressure, MS, diabetes, and arthritis all run in the family, but Rose has had no involvement as of yet. Rose had her first period at 14, and says that her periods are regular and do not give her cause for question or concern. She reports no allergies of any kind, and no allergies to medication that she knows of. Substance Abuse Rose smoked at least half a pack a day, from the time she was 14-17. Rose was drinking heavily from the time she turned 20 to just recently when she realized that she might be pregnant. She did experiment with drugs when she was younger, but it was when she was with other people and shes not sure exactly what she tried. She doesnt like being completely out of control and she felt that drugs made her completely lose it. Mental Health

6 Rose has struggled with self-esteem and depression in the past. When she was sixteen, her teachers noticed a change in her personality, and her school councilor recommended that she go to a psychologist. Rose went twice and then stopped when her mother didnt want to drive her to sessions, and especially didnt want to pay. Rose reports her mother to have said that needing therapy made one weak. Rose says that the little bit of therapy she had didnt help anything and instead learned to hide things better. Relationships and Sexual Abuse Rose has no lasting relationships from her childhood. She reports that she pushes all friends away and that people only last 2-3 years before they she gets sick of people. She always finds a way out when people get too close. Currently she states that she has a few friends, who were supportive when the breakup initially happened, but now they are busy with their own life. Rose began dating at fourteen. It was her first boyfriend (he was 16) who introduced her to smoking. Her second boyfriend (when she was 15) got her drunk and encouraged her to start having sex. She says that she wasnt ready, but she felt like she had to have sex or she would lose him. Her ex-fianc met her at a concert when she was sixteen, and she fell in love before moving in with him the minute she turned 18. She enjoyed her sexual life with her last boyfriend, and would have orgasms but not every time she had sex. At the moment she is not in a committed relationship, but was having occasional sex with a coworker. However when she found out she was pregnant, she stopped. She is not positive who the father is, as both her ex-fianc and her coworker do not like condoms and would refuse to wear them. She was on birth control, but isnt sure why that didnt work. Family of Origin

7 Rose was engaged on her nineteenth birthday, and had the wedding completely planned and paid for before breaking up a month before the wedding. Rose broke the relationship because she caught her fianc cheating with her best friend at the time, while she was asleep upstairs. Rose had a miscarriage at the age of eighteen but hadnt told anyone she was pregnant. She had her first pregnancy scare at seventeen but it was a false alarm. Her ex-fianc never abused her, but he was prone to violence and got in bar fights often. Military History Rose was never directly involved with the history, but her ex was in the Marines. He had enlisted the year before they met. Financial History Growing up (before her parents got divorced), Roses family always had enough to get by but her father did not manage money well and tended to spend all of his money on expensive electronics and clothing. When her parents split, money was tighter but there was always enough for the necessities. When her parents split up, her mother made the decision to walk away from their large home and moved into a condo. At the moment, the client reports that she is making good money and is able to buy what she needs. However her mother has used her credit cards and pushed them to the max renovating the condo and she is worried that if she continues to live with her mother, her mother will abuse her generosity and ruin her credit. Legal History There was a custody battle when her parents divorced, but Rose states that her mother won full rights.

8 Immigration Issues The client denies any knowledge of history of immigration issues. Religious History

Rose stated that her mother is Catholic and goes to church often. Her father considers himself a born-again Christian and attends Baptist services every week and encourages his children to attend with him. However Rose does not attend church and when asked, said that she just doesnt care. She doesnt consider herself a Christian, but she does not consider herself an atheist. She believes in a higher power, but doesnt know if this higher power cares about her. The client stated that she does not think about religion or religious issues very often. She finds that she has a problem believing god loves her if, because if he did, why is her life so messed up? Educational History Rose succeeded above her grade level in both primary school and middle school. She stopped putting in an effort, though, in high school and her grades started to decline. She graduated with a 2.5 gpa, and did not go to college right away. As of the moment, she is taking one night class a semester and was trying to save up to go to community college full-time, before she found out she was pregnant. When asked, the client stated that she felt that she was not bright, and her father used to make her feel even more stupid when he helped with homework. She truly does not believe that she has much to offer in an educational capacity but still wants to receive a college degree. Employment History

9 Rose is a store manager at a retail chain. She thoroughly enjoys her job and is hoping that she will be promoted to regional manager sometime in the future. This is her third year at the job, and her first year as a manager. She loves being in charge and knowing that she has authority, and is trusted to get the job done efficiently and correctly. The client enjoys that people come to her for help, knowing that she will know how to solve a situation. Rose works full-time, is paid hourly, and believes that they are paid consistently to the level of training. Before the retail job that Rose currently holds, she used to babysit. Rose watched children for three neighborhood families from the time she was twelve, until she began her job at the retail chain. She was not paid very much (sometimes not at all), but she says that she had enough for cigarettes and alcohol when she could find someone to buy it for her. The client states that she loved babysitting, and loved taking care of the children, but was unable to focus once she started experimenting with drugs and alcohol. As a child (and until she moved), chores were expected to be done and done correctly. There was no allowance given for chores. It was Roses responsibility to make her bed, clean her room, wash breakfast dishes, and tidy up any messes she made before school. The client states that there were times that she did not eat breakfast because she knew that she would not have time to wash the dishes before she had to go to school. After school, it was Roses responsibility to prepare a snack for her brother and herself, clean up, clean the bathrooms, vacuum the living room and hallway and then dust the living room. Her mother liked to come home after work to a tidy home, and if the chores werent done certain privileges (such as television, reading time, etc. were taken away). Strengths of the Client

10 The client believes that the fact that she left when she learned her ex-fianc cheated on her would be considered strength. She did not want to live in a relationship that was not honest. The client wants to better herself, and is taking night classes, as well as planning on going to school full-time as soon as she can fit it into her schedule and finances. During the interview, the client identified a several support persons. She finds that her grandmother and aunt are supportive when she tells them what is going on in her life. She also believes that she has a fair relationship with her brother even though he has quite a temper. She admits the relationship can be stressful but knows that he loves her and wants the best for her. She reports that helping her brother (when he lets her) in any way gives her pride. The client is a hardworking, loyal, and dedicated in the workplace. She believes she will be further promoted due to her excellent work ethic, and wants to go to school to provide a better life for herself and her unborn child. The only person who knows about the pregnancy is her grandmother, and Rose reports that her grandmother is extremely supportive and has offered her home to Rose and her unborn child until she can get on her own feet, an offer which Rose believes she will be taking. Her grandmother has even offered to help pay for some schooling, with the stipulation that Rose pays her back (without interest) when she graduates and gets a job with her degree, and this is an offer that Rose is also considering. Rose wants to better her life, and came to sessions willingly. She knows that with hard work and dedication she can achieve the goals she has made. Rose is in excellent shape and no longer feels the need to smoke, drink, or has any urges to return to her eating disorder. The client wants to provide the best for her unborn child, even though

11 she knows it will be hard without the childs father in the picture. However, she does not want her child to be raised with a cheater.

Step One: Working with the client Rose has discussed various issues with me that she has been dealing with, and she would like to address, and work on each of these issues. She feels that she cannot handle these issues on her own, so she feels that professional help would be extremely beneficial. 1. The client is struggling with feelings of inadequacy. She is worried that she will be a bad mother since she did not have a good role model. This is causing her a great deal of anxiety. 2. The client is terrified to tell anyone about her pregnancy. She feels that her mother might disown her. She is also worried about telling her coworkers, as she is worried that she might be fired. 3. The client is depressed since her breakup with her fianc. She is also angry that she is depressed. She believes that she did the right thing, but doesnt know why she is so upset. She is also struggling with frustration, anger, and depression about being back at home with her mother. Prioritize Problems: Due to conversations and my understanding of where Rose is, and of her case as a hole, the problems are prioritized as follows: 1. Roses feelings of inadequacy. 2. Telling people about her pregnancy. 3. The depression and anger she is feeling on a day to day basis.

12 4. Finding out who the father of her unborn child. Translating the problems into need: Problem: 1. Feelings of inadequacy. Need: 1. To gain confidence in herself as a future mother 2. Speaking to others about pregnancy 2. To be able to speak about her pregnancy without crippling anxiety. 3. Depression and anger 3. Skills at coping, and possible medical care for depression

Evaluate levels of intervention for each need Need #1: Feelings of inadequacy in regards to being a mother. Micro strategy: Read recommended books on parenting. Pros: The client will be able to read different strategies for parenting. By reading multiple books, the client can begin to understand what she does and does not agree with, and can then begin to picture herself as a parent. The books may be readily available at the library, or are available for purchase at a local bookstore (or even on handheld readers).

13 The client does not need to read all the books at once, she can take her time with them, as she has a few more months until the child is born. She can also read different testimonies from women in her position and how they managed their stress and possible feelings of inadequacy. Cons: The books may not be offered at the library, or they may be checked out and have a waiting list. The books may be expensive and on her already limited budget she may not be able to afford them. She will have to set time aside to read the books (especially since there are more than one) and she already has a full schedule. Mezzo strategy: Attend pregnancy support groups and/or take parenting classes. Pros: A support group would provide Rose with the support that she is lacking from people who are going through or have already gone through the same thing. Parenting classes would increase her confidence in her parenting skills. Both would give Rose tools to cope with her pregnancy and her choice to be a single, working mother. Cons: There may not be any support groups for Rose to join.

14 She may have to pay for parenting classes, and if so, it may be more money than she can afford as she is already on a budget. Both the classes and the support group could meet when Rose is unavailable to attend due to her work schedule. Macro strategy: macro strategy does not apply because all the resources are readily available.

Need #2: Telling people about her pregnancy. Micro strategy: begin by telling friends, and people that Rose do not believe will judge her too harshly, and then working up to telling her workplace and mother. Utilize the positive reaction from her grandmother to encourage telling more people. Pros: By working up to the harder reveals, Rose is allowing herself the chance for friends to be excited and happy for her pregnancy. Telling people before her mother will increase Roses confidence until she will struggle less with telling her mother. By her grandmother being supportive and excited for Rose, she can anticipate a similar reaction from her mother. Cons:

15 Friends might not be as supportive as Rose could hope. Their reactions could be negative, which would decrease her confidence and allow her to fear telling her mother even more. Her work could fire her. Roses mother could disown her daughter due to unwed pregnancy.

Mezzo strategy: obtain family counseling. Pros: The environment in which Rose reveals to her mother that she is pregnant would be a moderated environment, with no chance for name calling, or other insulting reactions. Rose and her mother (and presumably brother) would be able to discuss and work on issues that are affecting them on a grander scale, resulting in a more positive relationship. The insurance that Rose or her mother has might cover some of the cost for family counseling. Cons: Insurance might not cover family counseling. Roses mother and brother might decline to attend family counseling. The issues discussed in therapy might be discussed outside therapy, and could cause more strain on the already strained relationship.

16 The family might not be able to find a time that works for all three of them to attend counseling (or may not attempt to find a time). Macro strategy: macro strategy does not apply because all the resources are readily available.

Need #3: Feelings of depression and anger.

Micro strategy: finding a way to deal with the feelings of depression or anger. Such as yoga (in moderation), a hobby, meditation, working out (also in moderation) etc. Pros: Yoga/working out would not only establish and maintain healthy stress relief, it would allow Rose a healthy way for blowing off steam. Yoga/working out could also result in meeting new friends who encourage a healthy lifestyle. Rose would be able to pour her feelings of depression or anger into something productive and not self-harming (as she did in the past before she became pregnant). Any of the suggestions above could be continued after she has the child, to provide stress relief. Cons: There are yoga and meditation videos online that the client could utilize.

17 The client may not have the time or money to go to yoga/a gym. If not monitored and/or careful the client could over-do it and harm herself or the baby. The client may not find that any of these methods are calming.

Mezzo strategy: see a professional to deal with these issues of depression and anger. Pros: The professional could teach her ways of coping that she could not otherwise learn. The professional would be able to provide ongoing (if the client chooses) therapy. This professional would be one more person that Rose has in her corner. Insurance could cover some or all of the fees associated with the visits to a professional. Cons: Insurance might not cover the cost of the visits. Rose might be embarrassed to go to a professional for help. Rose might not be able to fit these visits into her already busy schedule.

Macro strategy: macro strategy does not apply because all the resources are readily available.

Goals, objectives, and tasks:

18 Goal #1: Improve feelings of inadequacy. I. The client will obtain at least one (preferably more than one) book about parenting. a. The client will determine if the book can be borrowed or bought within three days. b. The client will buy/borrow the book(s) within five days. c. The client will then read at least one book within two weeks. The client will take notes (or highlight if the book belongs to her) on skills, methods, or anything that she would like to try. II. The client will locate and join a support group within two weeks. a. Locate a support group within 5 days. b. Obtain information including what the client needs to do to join said support group within 7 days. c. Attend a group session within two weeks. Goal #2: The client will begin to tell people about her pregnancy. I. The client will tell friends about her pregnancy first. a. Rose will tell at least one friend about her pregnancy within three days. b. Rose will then tell at least two more people about her pregnancy within seven days.

19 II. The client will obtain family counseling. a. Rose will contact her family doctor for a referral within four days. b. The client will contact the referred professional and make an appointment within seven days. c. Rose and her family will attend the scheduled appointment within the next month and begin to work on their issues, and Rose will tell her family about her pregnancy. Goal #3: Rose will begin to work on managing her feelings of depression and anger. I. Rose will choose a hobby a. Rose will try different methods of dealing with her depression and anger in the next week. b. Rose will then make a commitment to continuing to do that method regularly. c. The client will keep a journal of how the hobby is making her feel as she continues to do it regularly. II. Rose will contact a professional to deal with her feelings. a. Rose will contact her family doctor within four days for a referral. b. Rose will call the referral and make an appointment within seven days. c. Rose will attend the session with the professional within a month.

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