Imagine that some of your colleagues mention using cognitive behavior therapy, dialectical behavioral therapy, acceptance and commitment therapy, and reality therapy. Your colleagues cont

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Theory Into Practice: Four Social Work Case Studies In this course, you select one of the following four case studies and use it throughout the entire course. By doing this, you will have the opportunity to see how different theories guide your view of a client and that client’s presenting problem. Each time you return to the same case, you will use a different theory, and your perspective of the problem will change—which then changes how you ask assessment questions and how you intervene.

Table of Contents Ella Schultz ……………………………………………………………………………………………………… 2 Paula Cortez ……………………………………………………………………………………………………. 9 Sam Franklin ………………………………………………………………………………………………….. 10 Helen Petrakis ………………………………………………………………………………………………… 13

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Ella Schultz Identifying Data Ella Schultz is a 16-year-old White female of German decent. She was raised in Ohio. Ella’s family consists of her father, Robert (44 years old), and her mother, Rose (39 years old). Ella currently resides in a residential group home, where she has been since she ran away from home. Ella has been provided room and board in the residential treatment facility for the past 3 months. Ella describes herself as bi-sexual. Presenting Problem Ella has been living homeless for 13 months. She has been arrested on two occasions for shoplifting and once for loitering (as a teen in need of supervision) in the last 7 months. Ella has recently been court ordered to reside in a group home with counseling. She refuses to return home due to the abuse she experienced. After 3 months at Teens First, Ella said she is thinking about reinitiating contact with her mother. She has not seen either parent in 6 months and missed the stability of the way her family “used to be,” although she is also conflicted due to recognizing the instability of her family. Ella is confused about the path to follow. Family Dynamics Ella indicates that her family worked well until her father began drinking heavily about 3 years ago. She remembers her parents being social and going out or having friends over for drinks, but she never remembered them becoming drunk. Then, her father lost his job as an information technology (IT) support professional and was unable to find meaningful work. He took on part-time jobs at electronics stores, but they left him demoralized. Her parents stopped socializing, and then her father was fired from his last job because he arrived drunk. Ella’s father would regularly be drunk by the time she arrived home from school. When Ella started having trouble in school, her father would berate her when she came home if she didn’t study immediately. Then, he would interrupt her studies by following her around and verbally abusing her. Soon after, he began hitting her or throwing objects at her. Once she went to the emergency room for stitches on her brow when she was struck by a drinking glass her father threw. She was able to convince the emergency room (ER) staff, however, that it was a bike accident, as she was known as an avid biker around her community, often riding to and from school and elsewhere. Ella’s mother did not witness these events, as they often occurred before she returned from work, and her father might be passed out by this time. Ella reports that her mother was in denial about her father, often pretending there was no issue. When Ella tried to report the abuse, her mother took her father’s side. Finally, after the stitches, Ella confronted her mom with her father present. Her father denied it, flew into a rage, and then physically abused both Ella and her mom. The next day, Ella’s mom acted as if nothing happened. After the abuse quickly escalated in the next week, to the point where she could no longer hide it or cover it up,

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Ella fled home and has been homeless since. She left a note before leaving for school one morning and did not return home. Educational History Ella attends school at the group home, taking general education classes for her general education development (GED) credential. Shortly after her father lost his job, Ella began experiencing learning disabilities. Her difficulties began in math, where she had difficulty sorting and making sense of numbers. Then she began to fall behind in her reading. Her grades went from a B average to consistent D’s. Some of Ella’s Instructors began to raise the issue of a possible learning disability. A counselor made an appointment to discuss possible causes, but Ella left school and home just prior to that meeting, and did not attend. Employment History Ella reports that her father was employed as an IT support professional at a bank. When the bank downsized and closed many branches, her father was laid off. He was unable to secure another IT support position, as many companies had begun outsourcing this work to contractors or overseas. He began to work part-time retail jobs at consumer electronics stores but quickly became demoralized and lost a series of those jobs. Her mother works as a full-time home health aide. Social History Ella reports that the homeless encampment (where she wound up for a long stretch) had a group of teens that stuck together for protection and to shield themselves and each other from certain bad choices. It was at this time that Ella reports she became bisexual, seeking out and bonding to a group of women who were able to avoid being exploited for human trafficking. The encampment group did still engage in risky behavior, however, including frequent shoplifting and other theft to secure food, supplies, etc. Likewise, although Ella reports that she did not engage in prostitution, she did engage in unprotected sex with one woman whose sexual history may have included prostitution or intravenous drug use. Thus Ella contracted a sexually transmitted infection (STI) in one instance. Ella reports she might consider trying to go home if she knew her father was no longer there, despite feeling betrayed by her mother. She would also be willing to reconcile and attend therapy with her. However, Ella feels that her mother, who comes from a very religious family (though does not practice much now), would ultimately reject her due to her bisexual identification. Ella also feels a strong bond to the group of teens and women with whom she stayed in the homeless encampment. She reports that she misses them and wishes she could see them—especially one teen in particular named Marisol. She says she considers these women to be as much, if not more, her family as her biological family.

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Mental Health History Ella began counseling to address the abuse in her history. In her initial reports, as detailed above, she cites mostly verbal and psychological abuse with only two instances of physical abuse. She denies any sexual abuse. When Ella recounts the physical abuse specifically, however, she shows added signs of acute distress and trauma. The physical harm caused by the event that triggered her leaving was reportedly significant—bruising on both arms, a split lip, a bloody nose, and a bump on the head—all from punches—as well as bruises on her leg from being kicked. She did not seek medical help and avoided as much social contact as possible the day she ran away, so as not to encourage inquiries about her home situation. Ella does have positive memories of what she calls “the before time,” and she shows a desire to return to that time. She worries for her mom, despite feeling betrayed by her. The last time she did have contact with her mom, she promised to leave her dad, but Ella does not know if this ever occurred. Legal History Ella has been arrested three times, twice for shoplifting and once for vagrancy. Citing the abuse she reported at home and the fears she felt, Ella was mandated to services at the Teens First agency, unlike her prior arrests when she was sent to detention. Alcohol and Drug Use History Ella denies any alcohol or drug use while living homeless. She reports the homeless encampment (where she wound up for a long stretch) had a group of teens that stuck together and were able to shield themselves from certain bad choices. Medical History During intake, it was noted that Ella showed signs of living homeless, including carrying all her possessions in one bag, signs of malnourishment, feet with heavy callouses, and clothing in disrepair. She did not show signs of drug use or self-harm. The STI she contracted was diagnosed upon intake, and she received antibiotics for treatment. Strengths Ella is resilient in learning how to survive in a difficult situation. She was able to avoid the more severe negative outcomes, such as human trafficking and drug use. She is able to form beneficial bonds for protection and support. Father: Robert Schultz (44 years old) Mother: Rose Schultz (39 years old) Daughter: Ella Schultz (16 years old)

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Paula Cortez

Identifying Data Paula Cortez is a 43-year-old Catholic Hispanic female residing in New York City, New York. Paula was born in Colombia. When she was 17 years old, Paula left Colombia and moved to New York where she met David, who later became her husband. Paula and David have one son, Miguel, 20 years old. They divorced after 5 years of marriage. Paula has a 5-year-old daughter, Maria, from a different relationship. Presenting Problem Paula has multiple medical issues, and there is concern about whether she will be able to continue to care for her youngest child, Maria. Paula has been overwhelmed, especially since she again stopped taking her medication. Paula is also concerned about the wellness of Maria. Family Dynamics Paula comes from a moderately well-to-do family. Paula reports suffering physical and emotional abuse at the hands of both her parents, eventually fleeing to New York to get away from the abuse. Paula comes from an authoritarian family where her role was to be “seen and not heard.” Paula states that she did not feel valued by any of her family members and reports never receiving the attention she needed. As a teenager, she realized she felt “not good enough” in her family system, which led to her leaving for New York and looking for “someone to love me.” Her parents still reside in Colombia with Paula’s two siblings. Paula met David when she sought to purchase drugs. They married when Paula was 18 years old. The couple divorced after 5 years of marriage. Paula raised Miguel, mostly by herself, until he was 8 years old, at which time she was forced to relinquish custody due to her medical condition. Paula maintains a relationship with her son, Miguel, and her ex-husband, David. Miguel takes part in caring for his half-sister, Maria. Paula does believe her job as a mother is to take care of Maria but is finding that more and more challenging with her physical illnesses. Employment History Paula worked for a clothing designer, but she realized that her true passion was painting. She has a collection of more than 100 drawings and paintings, many of which track the course of her personal and emotional journey. Paula held a full-time job for a number of years before her health prevented her from working. She is now unemployed and receives Supplemental Security Disability Insurance (SSD) and Medicaid. Miguel does his best to help his mom but only works part time at a local supermarket delivering groceries. Paula currently uses federal and state services. Paula successfully applied for WIC, the federal Supplemental Nutrition Program for Women, Infants, and Children. Given

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Paula’s low income, health, and Medicaid status, Paula is able to receive in-home childcare assistance through New York’s public assistance program. Social History Paula is bilingual, fluent in both Spanish and English. Although Paula identifies as Catholic, she does not consider religion to be a big part of her life. Paula lives with her daughter in an apartment in Queens, New York. Paula is socially isolated, as she has limited contact with her family in Colombia and lacks a peer network of any kind in her neighborhood. Five (5) years ago Paula met a man (Jesus) at a flower shop. They spoke several times. He would visit her at her apartment to have sex. Since they had an active sex life, Paula thought he was a “stand-up guy” and really liked him. She believed he would take care of her. Soon everything changed. Paula began to suspect that he was using drugs, because he had started to become controlling and demanding. He showed up at her apartment at all times of the night demanding to be let in. He called her relentlessly, and when she did not pick up the phone, he left her mean and threatening messages. Paula was fearful for her safety and thought her past behavior with drugs and sex brought on bad relationships with men and that she did not deserve better. After a couple of months, Paula realized she was pregnant. Jesus stated he did not want anything to do with the “kid” and stopped coming over, but he continued to contact and threaten Paula by phone. Paula has no contact with Jesus at this point in time due to a restraining order. Mental Health History Paula was diagnosed with bipolar disorder. She experiences periods of mania lasting for a couple of weeks, and then goes into a depressive state for months when not properly medicated. Paula has a tendency toward paranoia. Paula has a history of not complying with her psychiatric medication treatment because she does not like the way it makes her feel. She often discontinues it without telling her psychiatrist. Paula has had multiple psychiatric hospitalizations but has remained out of the hospital for the past 5 years. Paula accepts her bipolar diagnosis but demonstrates limited insight into the relationship between her symptoms and her medication. Paula reports that when she was pregnant, she was fearful for her safety due to the baby’s father’s anger about the pregnancy. Jesus’ relentless phone calls and voicemails rattled Paula. She believed she had nowhere to turn. At that time, she became scared, slept poorly, and her paranoia increased significantly. After completing a suicide assessment 5 years ago, it was noted that Paula was decompensating quickly and was at risk of harming herself and/or her baby. Paula was involuntarily admitted to the psychiatric unit of the hospital. Paula remained on the unit for 2 weeks. Educational History Paula completed high school in Colombia. Paula had hoped to attend the Fashion Institute of Technology (FIT) in New York City, but getting divorced, and then raising

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Miguel on her own, interfered with her plans. Miguel attends college full time in New York City. Medical History Paula was diagnosed as HIV positive 15 years ago. Paula acquired AIDS 3 years later when she was diagnosed with a severe brain infection and a T-cell count of less than 200. Paula’s brain infection left her completely paralyzed on the right side. She lost function in her right arm and hand, as well as her ability to walk. After a long stay in an acute care hospital in New York City, Paula was transferred to a skilled nursing facility (SNF) where she thought she would die. After being in the skilled nursing facility for more than a year, Paula regained the ability to walk, although she does so with a severe limp. She also regained some function in her right arm. Her right hand (her dominant hand) remains semi-paralyzed and limp. Over the course of several years, Paula taught herself to paint with her left hand and was able to return to her beloved art. Paula began treatment for her HIV/AIDS with highly active antiretroviral therapy (HAART). Since she ran away from the family home; married and divorced a drug user; and then was in an abusive relationship, Paula thought she deserved what she got in life. She responded well to HAART and her HIV/AIDS was well controlled. In addition to her HIV/AIDS disease, Paula is diagnosed with Hepatitis C (Hep C). While this condition was controlled, it has reached a point where Paula’s doctor recommends she begin a new treatment. Paula also has significant circulatory problems, which cause her severe pain in her lower extremities. She uses prescribed narcotic pain medication to control her symptoms. Paula’s circulatory problems led also to chronic ulcers on her feet that will not heal. Treatment for her foot ulcers demands frequent visits to a wound care clinic. Paula’s pain paired with the foot ulcers make it difficult for her to ambulate and leave her home. Paula has a tendency for noncompliance with her medical treatment. She often disregards instructions from her doctors and resorts to holistic treatments like treating her ulcers with chamomile tea. When she stops her treatment, she deteriorates quickly. Maria was born HIV negative and received the appropriate HAART treatment after birth. She spent a week in the neonatal intensive care unit, as she had to detox from the effects of the pain medication Paula took throughout her pregnancy. Legal History Previously, Paula used the AIDS Law Project, a not-for-profit organization that helps individuals with HIV address legal issues, such as those related to the child’s father. At that time, Paula filed a police report in response to Jesus' escalating threats and was successful in getting a restraining order. Once the order was served, the phone calls and visits stopped, and Paula regained a temporary sense of control over her life. Paula completed the appropriate permanency planning paperwork with the assistance of The Family Center organization. She named Miguel as her daughter’s guardian should something happen to her.

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Alcohol and Drug Use History Paula became an intravenous drug user (IVDU), using cocaine and heroin at age 17. David was one of Paula’s “drug buddies” and suppliers. Paula continued to use drugs in the United States for several years; however, she stopped when she got pregnant with Miguel. David continued to use drugs, which led to the failure of their marriage. Strengths Paula has shown resilience over the years. She has artistic skills and found a way to utilize them. Paula has the foresight to seek social services to help her and her children survive. Paula has no legal involvement. She has the ability to bounce back from her many physical and health challenges to continue to care for her child and maintain her household. Father: David Cortez (46 years old) Mother: Paula Cortez (43 years old) Son: Miguel Cortez (20 years old) Maria’s Father: Jesus (unknown last name, 44 years old) Daughter: Maria Cortez (5 years old)

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Sam Franklin Identifying Data Sam Franklin is a 41-year-old, married, African American male. Sam’s wife, Sheri, is 41 years old. They have two sons, Miles (10) and Raymond (8). The family resides in a three-bedroom home in a middle-class neighborhood in Rockville, Maryland. They have been married for 11 years. Presenting Problem Sam, a war veteran, came to the Veterans Affairs Health Care Center (VA) for services because his wife threatened to leave him if he does not get help. She is particularly concerned about his drinking and lack of involvement in their sons’ lives. She told him his drinking is out of control and is making him mean and distant. Sam reports he and his wife have been fighting a lot and that he drinks to take the edge off and help him sleep. Sam expresses fear of losing his job and his family if he does not get help. Sam identifies as the primary provider for his family and believes this is his responsibility as a husband and father. Sam realizes he may be putting that in jeopardy because of his drinking. He says he has never seen Sheri so angry before, and he sees she is at her limit with him and his behaviors. Family Dynamics Sam was born in Alabama to an African American family system. He reports his time growing up to have been within a “normal” family system with a large extended family in his town and nearby towns. He states he was emotionally close to his mother and worshipped his father. His father was strict but loving, pushing Sam to become fairly independent from a young age. His dad had previously been in the military and was raised with the understanding that his duty is to support his country. His family displayed traditional roles, with his dad supporting the family after he was discharged from military service. Sam was raised to believe that real men do not show weakness and must be the head of the household. Sam’s parents are deceased, and he has three older sisters who live in Atlanta. He is close to the sister who is close to him in age, and they talk frequently on the phone. Sam has not, however, shared his current struggles with any of his siblings. He is afraid to let them down. Sheri is an only child, and although her mother lives in the area, she offers little support. Her mother never approved of Sheri marrying Sam, so she thinks Sheri needs to deal with their problems on her own. Sam reports he has not been engaged with his sons at all since his return from Iraq, and he keeps to himself when he is at home. Sam and Sheri met during one of his stateside deployments prior to being deployed to Iraq. At the time, Sheri was still in college. Sam and Sheri both say they “fell for each other fast” and kept in touch during Sam’s deployment to Iraq. When Sam’s deployment was over, Sheri encouraged him to complete a bachelor’s degree while stationed back in the U.S. After Sam’s graduation, they married and had Miles within a year.

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Employment History Sam is employed as a human resources director for the military. Sam works in an office with civilians and military personnel and mostly gets along with people in the office. Sam is having difficulty getting up in the morning to go to work, which increases the stress level with Sheri. Shari is a special education teacher in a local elementary school. Sam thinks it is his responsibility to provide for his family and is having stress over what is happening to him at home and work. He thinks he is failing as a provider. Social History Sam and Sheri identify as Baptist and attend a local church on major holidays. They do not otherwise practice, though both were raised with stronger religious community. Sam used to be quite social in the neighborhood, but he is withdrawn and tends to keep to himself. He says he sometimes feels pressured to be more communicative and social. Sam believes he is socially inept and not able to develop friendships. He says he is able to “fake it” at work but is not sure how long that can last. The couple has some mutual couple friends, since Sheri gets involved with the parents in their sons’ school. However, because of Sam’s recent behaviors, their socializing with other couples has tapered off. He is very worried that Sheri will leave him due to the isolation. Mental Health History Sam reports that since retiring from the military 10 months ago, he has difficulty sleeping, frequent heart palpitations, and moodiness. After his deployment, during his stateside assignments, he reports he did not experience intense feelings from his experiences on the battlefield. He would occasionally have intense memories, but he reports that he was able to “lock them back up pretty quickly.” It is only since his retirement that these feelings arose. Sam has seen Dr. Zoe, a psychiatrist at the VA, who diagnosed him with post-traumatic stress disorder (PTSD). Dr. Zoe prescribed Paxil to help reduce his symptoms of anxiety and depression, and suggested Sam also begin counseling. Sam says he does not really understand what PTSD is, but thinks it refers to a person who is “going crazy.” He admits he thought was happening to him at times. Sam expresses concern that he will never feel “normal” again and says that when he drinks alcohol, his symptoms and the intensity of his emotions ease. Sam describes that he sometimes thinks he is back on the battlefield, which makes him feel uneasy and watchful. He hates the experience and tries to numb it. He has difficulty sleeping and is irritable, so he isolates himself and soothes this with drinking. He talks about always feeling “ready to go.” He says he is exhausted from being always alert and looking for potential problems around him. Every sound seems to startle him. He shares that he often thinks about what happened “over there” but tries to push it out of his mind. Nighttime is the worst, as Sam has terrible recurring nightmares of one particular event. He says he wakes up shaking and sweating most nights. He adds that drinking is the one thing that seems to give him a little relief.

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Despite his close and normally supportive relationship with his sisters, Sam is unwilling to share his struggles with them. He fears that he will let them down and prove that he is not able to carry on the strong provider and family patriarch role of their father. He sees this role as crucial to his self-identity. Sam reports that he never saw his father drunk and is ashamed that his own children may have a memories of him being drunk. Educational History Sheri has a bachelor’s degree in special education from a local college. Sam received a bachelor’s degree in human resources management upon his return from the military. Military History Sam is an Iraqi War veteran. He enlisted in the Marines at 18 years old. Sam was stationed in several states prior to Sam being deployed to Iraq. Sam left the service 10 months ago but still works in human resources as a civilian. Medical History Sam is physically fit but an injury he sustained in combat sometimes limits his ability to use his left hand. Sam reports sometimes feeling inadequate because of the reduction in the use of his hand, but he tries to push through because he worries how the injury will impact his responsibilities as a provider, husband, and father. Sam considers himself resilient enough to overcome this disadvantage and “be able to do the things I need to do.” Sheri is in good physical condition and has recently found out that she is pregnant with their third child. Legal History Sam and Sheri deny having criminal histories. Alcohol and Drug Use History As teenagers, Sam and Sheri used marijuana and drank. Both deny current use of marijuana but report they still drink. Sheri drinks socially and has one or two drinks over the weekend. Sam reports that he has four to five drinks in the evenings during the week and eight to 10 drinks on Saturdays and Sundays. Sam spends his evenings on the couch drinking beer and watching TV or playing video games. Shari reports that Sam drinks more than he realizes, doubling what Sam has reported. Strengths Sam is cognizant of his limitations and has worked on overcoming his physical challenges. Sam is resilient. Sam did not have any disciplinary actions taken against him in the military. He is dedicated to his wife and family. Father: Sam Franklin (31 years old) Mother: Sheri Franklin (28 years old) Son 1: Miles Franklin (10 years old) Son 2: Raymond Franklin (8 years old)

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Helen Petrakis Identifying Data Helen Petrakis is a 52-year-old, Caucasian female of Greek descent living in a four- bedroom house in Tarpon Springs, Florida. Her family consists of her husband, John (60), son, Alec (27), daughter, Dmitra (23), and daughter Althima (18). John and Helen have been married for 30 years. They married in the Greek Orthodox Church and attend services weekly. Presenting Problem Helen reports feeling overwhelmed and “blue.” She was referred by a close friend who thought Helen would benefit from having a person who would listen. Although she is uncomfortable talking about her life with a stranger, Helen says that she decided to come for therapy because she worries about burdening friends with her troubles. John has been expressing his displeasure with meals at home, as Helen has been cooking less often and brings home takeout. Helen thinks she is inadequate as a wife. She states that she feels defeated; she describes an incident in which her son, Alec, expressed disappointment in her because she could not provide him with clean laundry. Helen reports feeling overwhelmed by her responsibilities and believes she can’t handle being a wife, mother, and caretaker any longer. Family Dynamics Helen describes her marriage as typical of a traditional Greek family. John, the breadwinner in the family, is successful in the souvenir shop in town. Helen voices a great deal of pride in her children. Dmitra is described as smart, beautiful, and hardworking. Althima is described as adorable and reliable. Helen shops, cooks, and cleans for the family, and John sees to yard care and maintaining the family’s cars. Helen believes the children are too busy to be expected to help around the house, knowing that is her role as wife and mother. John and Helen choose not to take money from their children for any room or board. The Petrakis family holds strong family bonds within a large and supportive Greek community. Helen is the primary caretaker for Magda (John’s 81-year-old widowed mother), who lives in an apartment 30 minutes away. Until recently, Magda was self-sufficient, coming for weekly family dinners and driving herself shopping and to church. Six months ago, she fell and broke her hip and was also recently diagnosed with early signs of dementia. Helen and John hired a reliable and trusted woman temporarily to check in on Magda a couple of days each week. Helen would go and see Magda on the other days, sometimes twice in one day, depending on Magda’s needs. Helen would go food shoppin

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