Home – Page 68 – Homework Handlers

Discuss one cognitive or one pharmacological therapy you feel has significant potential in treating clients.

June 17, 2023/in Uncategorized /by SK

PART 1

Discuss one cognitive or one pharmacological therapy you feel has significant potential in treating clients. Identify a disorder that it is used as a treatment. What new research supports this?

PART2

Review research literature on autism and provide information on it as both a neurological disorder and developmental disorder. Is there evidence for abnormal brain development? Based on this review, describe one theory as to the cause of autism.

PART3

Review this week’s course materials and learning activities, and reflect on your learning so far this week. Respond to one or more of the following prompts in one to two paragraphs:

Provide citation and reference to the material(s) you discuss. Describe what you found interesting regarding this topic, and why.
Describe how you will apply that learning in your daily life, including your work life.
Describe what may be unclear to you, and what you would like to learn.

PART4- INDIVIDUAL PROGRAMMATIC ASSESSMENT DISORDER PAPER

Select a neurological, psychological, or neurodevelopmental disorder.

Write a 2,450- to 3,500-word paper comparing and contrasting three therapeutic interventions used to treat this disorder. Compare measures of effectiveness, such as validity, efficacy, symptom and behavior management, and recidivism. One therapy should be cognitive in nature, one should be pharmacological in nature, and the third should be an alternative therapeutic treatment.

Identify common symptoms associated with your disorder and rates of symptom reduction or management as reported with the three treatments. Based on your research, what would be your approach to treating the condition? Identify which treatments you would use. Explain why.

Analyze the neurophysiological underpinnings of diseases and disorders.

Examine contemporary attitudes toward the three treatments you selected.

Format your paper consistent with APA guidelines.

Include 7 to 10 peer-reviewed sources.

Submit your assignment.

Individual Programmatic Assessment: Disorde

Wk 5 Individual: Individual Programmatic Assessment: Disorder

chapter 16 Schizophrenia and the Affective Disorders

Outline

· ■ Schizophrenia

Description

Heritability

Pharmacology of Schizophrenia: The Dopamine Hypothesis

Schizophrenia as a Neurological Disorder

Section Summary

· ■ Major Affective Disorders

Description

Heritability

Season of Birth

Biological Treatments

The Monoamine Hypothesis

Role of the 5-HT Transporter

Role of the Frontal Cortex

Role of Neurogenesis

Role of Circadian Rhythms

Section Summary

Larry had become a permanent resident of the state hospital. His parents had originally hoped that treatment would help him enough that he could live in a halfway house with a small group of other young men, but his condition was so serious that he required constant supervision. Larry had severe schizophrenia. The medication he was taking helped, but he still exhibited severe psychotic symptoms. In addition, he had begun showing signs of a neurological disorder that seemed to be getting worse.

Larry had always been a difficult child, shy and socially awkward. He had no real friends. During adolescence he became even more withdrawn and insisted that his parents and older sister keep out of his room. He stopped taking meals with the family, and he even bought a small refrigerator of his own for his room so that he could keep his own food, which he said he preferred to that “pesticide-contaminated” food his parents ate. His grades in school, which were never outstanding, got progressively worse, and when he was seventeen years old, he dropped out of high school.

Larry’s parents recognized that something was seriously wrong with him. Their family physician suggested that Larry see a psychiatrist and gave them the name of a colleague that he respected, but Larry flatly refused to go. Within a year after he had quit high school, he became frankly psychotic. He heard voices talking to him, and sometimes his parents could hear him shouting for the voices to go away. He was convinced that his parents were trying to poison him, and he would eat only factory-sealed food that he had opened himself. Although he kept his body clean—sometimes he would stand in the shower for an hour “purifying” himself—his room became frightfully messy. He insisted on keeping old cans and food packages because, he said, he needed to compare them with items his parents brought from the store to be sure they were not counterfeit.

One day, while Larry was in the shower purifying himself, his mother cleaned his room. She filled several large plastic garbage bags with the cans and packages and put them out for the trash collector. As she reentered the house, she heard a howling noise from upstairs. Larry had emerged from the shower and discovered that his room had been cleaned. When he saw his mother coming up the stairs, he screamed at her, cursed her savagely, and rushed down the stairs toward her. He hit her so hard that she fell down the stairs, landing heavily on the floor below. He wheeled around, ran up the stairs, and went into his room, slamming the door behind him.

An hour later, Larry’s father discovered his wife unconscious at the foot of the stairs. She soon recovered from the mild concussion she had sustained, but Larry’s parents realized that it was time for him to be put in custody. Because he had attacked his mother, a judge ordered that he be temporarily detained and, as a result of a psychiatric evaluation, had him committed to the state hospital. The diagnosis was “schizophrenia, paranoid type.”

In the state hospital, Larry was given Thorazine (chlorpromazine), which helped considerably. For the first few weeks, he showed some symptoms that are commonly seen in Parkinson’s disease—tremors, rigidity, a shuffling gait, and lack of facial expression—but these symptoms cleared up spontaneously, as his physician had predicted. The voices still talked to him occasionally, but less often than before, and even then he could ignore them most of the time. His suspiciousness decreased, and he was willing to eat with the residents in the dining room. But he still obviously had paranoid delusions, and the psychiatric staff was unwilling to let him leave the hospital. For one thing, he refused to take his medication voluntarily. Once, after he had suffered a serious relapse, the staff discovered that he had only been pretending to swallow his pills and was later throwing them away. After that, they made sure that he swallowed them.

After several years, Larry began developing more serious neurological symptoms. He began pursing his lips and making puffing sounds; later, he started grimacing, sticking his tongue out, and turning his head sharply to the left. The symptoms became so severe that they interfered with his ability to eat. His physician prescribed an additional drug, which reduced the symptoms considerably but did not eliminate them. As he explained to Larry’s parents, “His neurological problems are caused by the medication that we are using to help with his psychiatric symptoms. These problems usually do not develop until a patient has taken the medication for many years, but Larry appears to be one of the unfortunate exceptions. If we take him off the medication, the neurological symptoms will get even worse. We could reduce the symptoms by giving him a higher dose of the medication, but then the problem would come back later, and it would be even worse. All we can do is try to treat the symptoms with another drug, as we have been doing. We really need a medication that helps treat schizophrenia without producing these tragic side effects.”

Most of the discussion in this book has concentrated on the physiology of normal, adaptive behavior. The last three chapters summarize research on the nature and physiology of syndromes characterized by maladaptive behavior: mental disorders and drug abuse. The symptoms of mental disorders include deficient or inappropriate social behaviors; illogical, incoherent, or obsessional thoughts; inappropriate emotional responses, including depression, mania, or anxiety; and delusions and hallucinations. Research in recent years indicates that many of these symptoms are caused by abnormalities in the brain, both structural and biochemical.

This chapter discusses two serious mental disorders: schizophrenia and the major affective disorders. Chapter 17 discusses anxiety disorders, autism, attention deficit disorder, and disorders caused by stress. Chapter 18 discusses drug abuse.

Schizophrenia

Description

Schizophrenia is a serious mental disorder that afflicts approximately 1 percent of the world’s population. Its monetary cost to society is enormous; in the United States this figure exceeds that of the cost of all cancers (Thaker and Carpenter, 2001 ). Descriptions of symptoms in ancient writings indicate that the disorder has been around for thousands of years (Jeste et al., 1985 ). The major symptoms of schizophrenia are universal, and clinicians have developed criteria for reliably diagnosing the disorder in people of a wide variety of cultures (Flaum and Andreasen, 1990 ). Schizophrenia is probably the most misused psychological term in existence. The word literally means “split mind,” but it does not imply a split or multiple personality. People often say that they “feel schizophrenic” about an issue when they really mean that they have mixed feelings about it. A person who sometimes wants to build a cabin in the wilderness and live off the land and at other times wants to take over the family insurance agency might be undecided, but he or she is not schizophrenic. The man who invented the term, Eugen Bleuler ( 1911/1950 ), intended it to refer to a break with reality caused by disorganization of the various functions of the mind, such that thoughts and feelings no longer worked together normally.

Schizophrenia is characterized by three categories of symptoms: positive, negative, and cognitive (Mueser and McGurk, 2004). Positive symptoms make themselves known by their presence. They include thought disorders, hallucinations, and delusions. A thought disorder —disorganized, irrational thinking—is probably the most important symptom of schizophrenia. Schizophrenics have great difficulty arranging their thoughts logically and sorting out plausible conclusions from absurd ones. In conversation they jump from one topic to another as new associations come up. Sometimes, they utter meaningless words or choose words for rhyme rather than for meaning. Delusions are beliefs that are obviously contrary to fact. Delusions of persecution are false beliefs that others are plotting and conspiring against oneself. Delusions of grandeur are false beliefs in one’s power and importance, such as a conviction that one has godlike powers or has special knowledge that no one else possesses. Delusions of control are related to delusions of persecution; the person believes (for example) that he or she is being controlled by others through such means as radar or a tiny radio receiver implanted in his or her brain.

schizophrenia A serious mental disorder characterized by disordered thoughts, delusions, hallucinations, and often bizarre behaviors.

positive symptom A symptom of schizophrenia evident by its presence: delusions, hallucinations, or thought disorders.

thought disorder Disorganized, irrational thinking.

delusion A belief that is clearly in contradiction to reality.

The third positive symptom of schizophrenia is hallucinations , perceptions of stimuli that are not actually present. The most common schizophrenic hallucinations are auditory, but they can also involve any of the other senses. The typical schizophrenic hallucination consists of voices talking to the person. Sometimes, the voices order the person to do something; sometimes, they scold the person for his or her unworthiness; sometimes, they just utter meaningless phrases. Olfactory hallucinations are also fairly common; often they contribute to the delusion that others are trying to kill the person with poison gas. (See Table 16.1 . )

hallucination Perception of a nonexistent object or event.

In contrast to the positive symptoms, the negative symptoms of schizophrenia are known by the absence or diminution of normal behaviors: flattened emotional response, poverty of speech, lack of initiative and persistence, anhedonia (inability to experience pleasure), and social withdrawal. The cognitive symptoms of schizophrenia are closely related to the negative symptoms and may be produced by abnormalities in overlapping brain regions. These symptoms include difficulty in sustaining attention, low psychomotor speed (the ability to rapidly and fluently perform movements of the fingers, hands, and legs), deficits in learning and memory, poor abstract thinking, and poor problem solving. Negative symptoms and cognitive symptoms are not specific to schizophrenia; they are seen in many neurological disorders that involve brain damage, especially to the frontal lobes. As we will see later in this chapter, positive symptoms appear to involve excessive activity in some neural circuits that include dopamine as a neurotransmitter, and negative symptoms and cognitive symptoms appear to be caused by developmental or degenerative processes that impair the normal functions of some regions of the brain. (Look again at Table 16.1 . )

Evaluate the authors’ use of literature using the Use of Literature Checklist as a guide.

June 17, 2023/in Uncategorized /by SK

Surveillance as casework: supervising domestic violence defendants with GPS technology

Peter R. Ibarra & Oren M. Gur & Edna Erez

Published online: 27 September 2014 # Springer Science+Business Media Dordrecht 2014

Abstract Academic discussion about surveillance tends to emphasize its proliferation, ubiquity, and impact on society, while neglecting to consider the continued relevance of traditional approaches to human supervision, an oversight insofar as surveillance is organized through practices embedded in justice system-based casework. Drawing from a multi-site study of pretrial personnel utilizing global positioning system (GPS) technology for domestic violence cases in the U.S., a comparative analysis is offered to illustrate how the handling of a “problem population” varies across commu- nity corrections agencies as they implement surveillance regimes. In particular, the study finds that surveillance styles reflect whether an agency is directed toward crime control and risk management, providing treatment and assistance, or observing due process. These programmatic thrusts are expressed in how officers interact with offenders as cases, both directly and remotely. In contrast to the ambient monitoring of environments and populations through data-banking technologies, the interactive surveillance styles described in the present study highlight the role of casework in surveillance.

Introduction

Surveillance has become pervasive as information systems that document people’s quotidian activities have multiplied [49]. These systems collect steadily increasing streams of personal information that are stored in unevenly regulated, coordinated, and accessible data banks, to be tapped into on an “as needed” basis by market- and government-based actors.1 The assembly and retrieval of these digitized data reflect the institutionalization of surveillance as an ordinary and “ubiquitous” feature of

Crime Law Soc Change (2014) 62:417–444 DOI 10.1007/s10611-014-9536-4

1These data banks need not be remotely located; for example, “smart phones” provide veritable troves of banked data (cf. [69]).

P. R. Ibarra (*): O. M. Gur: E. Erez Department of Criminology, Law, and Justice, University of Illinois at Chicago, 1007 W. Harrison St., BSB 4022 (M/C 141), Chicago, IL 60607, USA e-mail: pibarra@uic.edu

O. M. Gur Department of Criminal Justice, Pennsylvania State University, Abington College, Abington, PA 19001, USA

contemporary life [28]. Such ambient surveillance entails the kind of data collection and information management that occurs routinely, silently, and unobtrusively when, for example, visiting web sites, swiping ID cards upon entry to a secured facility, dialing telephone numbers, having one’s image captured on closed-circuit television (CCTV), carrying credit cards containing radio frequency (RF) ID tags, or using social media.2

A number of academic disciplines consider surveillance an object of inquiry; of interest to criminology is the penetration of surveillance technologies across all phases of the criminal justice process. These developments reflect broader trends in the growth of the “surveillant assemblage” [36], whereby surveillance has become increasingly democratized3 and embedded, i.e., “rhizomatic” ([36], p. 614, citing [18]). Key to understanding surveillance in United States criminal justice contexts is the idea of the case, for the fact that a person is a case means that surveillance becomes interactive, shaped less by its ubiquitous reach and more by the focused processes that organize, for example, supervision or investigation. Whereas ambient surveillance is faceless, dif- fuse, and operates impersonally, interactive surveillance is personified, focused, and pursued in response to a person’s status, identity, or actions.4 Interactive surveillance is purposeful and directed, characterized by unique practices—often including the use of face-to-face interaction—that yield information not necessarily digitized or searchable on demand or by algorithm. Interactive surveillance entails, minimally, interaction between a surveilling agent and an object of surveillance: a case. Rather than consti- tuting a bifurcated pairing, however, ambient and interactive surveillance can function symbiotically: exemplifying “function creep” ([17], passim) [48] (cf. [87]), i.e., the repurposing of technological tools and systems, innovations adopted by justice institu- tions appropriate extant surveillant data streams while also contributing to their growth.

Although electronic monitoring (EM) is a common basis for the surveillance of criminal justice populations in the U.S., scholarly investigation has focused on evalu- ating EM’s impact on various outcomes (e.g., desistance, compliance, recidivism) (e.g., [68, 64, 2]), rather than documenting the surveillance processes it engenders.5 The purpose of the current study is to examine “styles of surveillance” among community corrections officers using EM, employing a specific and comparative analysis (cf. [30])

2 Ambient surveillance emerges from the rise of ubiquitous computing and ambient intelligence (cf. [83]), which essentially document in digitized form an increasing range of human traces (“footprints”) and actions (current location, vehicular movements, economic transactions, interpersonal contacts, online behavior, etc.) (cf. [70, 81]). Ambient surveillance is distinguished from mass surveillance in that the latter is directed by the state, whereas the former encompasses both state- and market-based forms of surveillance. 3 Surveillance has become democratized as people increasingly have their lives and routine activities recorded, documented, tracked, and rendered into searchable databases, including socially powerful individuals who historically could use their status to shield themselves from bureaucratic organizations that might seek to monitor them (see [36], p. 618). 4 Because it works “silently,” ambient surveillance can be ignored, forgotten, and taken-for-granted, or become the subject of folklore, rumor, and speculation, and hence the object of collective action, such as when users of a smart phone application organize to protest changes in a social media company’s “privacy” policies [43]. By contrast, interactive surveillance is difficult to mobilize against politically insofar as those subject to it feel restricted in expressing their rights (e.g., to liberty, privacy), are unaware of their status as a case, or are deemed unsympathetic figures to “rally around.” Nevertheless, on an individual level, it is evident that resistance and sabotage may be practiced by those subjected to electronic surveillance. 5 There has also been extensive work examining how offenders experience the condition of being electron- ically monitored (e.g., [67, 38, 41, 23]).

418 P.R. Ibarra et al.

of how the tools of surveillance are integrated into local agendas and routines, variegated traditions and ideologies, and legal and extralegal considerations associated with social control and rule enforcement. Specifically, we examine how a “second generation” [52] EM technology—GPS—is implemented through interactive surveil- lance with domestic violence (DV) defendants in three U.S. jurisdictions. GPS tracking is an instructive technology for conceptualizing the distinction between interactive and ambient surveillance, for it targets a specific group—a set of cases—rather than a general population, and yet its constantly-banked data streams mimic the behavior of ambient forms.

The capabilities of technologies, including GPS tracking, do not describe or explain the practice of surveillance, either in general or as conducted by the criminal justice “system” (cf. [51]). Discussions of the “surveillance society” [50] often posit a unidimensionality to technology-based surveillance that is not supported empirically. According to David Lyon:

Surveillance today is often thought of only in technological terms. Technologies are indeed crucially important, but two important things must also be remem- bered: One, ‘human surveillance’ of a direct kind, unmediated by technology, still occurs and is often yoked with more technological kinds. Two, technological systems themselves are neither the cause nor the sum of what surveillance is today. We cannot simply read surveillance consequences off the capacities of each new system ([50], p. 6).

Surveillance technology acquires its “effects” from how it is used, but surveillance and technology are not coterminous. It is crucial to investigate how technologies are incorporated into the practice of surveillance, and not assume that any given technology is implemented identically by surveilling authorities or with the heterogeneous popu- lations brought under their purview. Paterson and Clamp [66] correctly note:

It is essential to understand surveillance technologies as social and policy con- structs where the function of the technology is determined by the environment in which it is utilized and experienced by the public. Technology manifests itself in different forms in different socio-political and cultural contexts. Therefore, new surveillance programmes must be understood as products of their environment; they are creations of the criminal justice agencies which have developed them and the offenders/victims who interact with the technology ([66], p. 53-4).

As new forms of technology appear, they are “constructed” as useful in responding to “problems” [77, 42] framed through local, instead of, or in addition to, national lenses, and incorporated into pre-existing justice infrastructures. In the current case, EM technology was adopted by courts’ pretrial services programs as a way of ameliorating a “problem” that prior means had been unable to effectively address: keeping DV victims “safe” from their alleged abusers pending adjudication and disposition of a criminal case. Yet, as illustrated below, surveillance technology has been implemented dissimilarly across jurisdictions.

We argue for a view of surveillance as casework (cf. [75]) embedded within interactive processes emerging from defendant-focused regimes of social control. The

Surveillance as casework: supervising domestic violence 419

ends of social control shape the styles of casework, and hence how surveillance is mobilized and experienced. Accordingly, the means and ends of social control should be identified in interpreting the organization and practice of surveillance. Characteristic styles of agency practice vary, highlighting the importance of describing and analyzing surveillant technologies in context. GPS tracking is not simply a mechanism for enforcing curfew and mobility restrictions on DV defendants; rather, its compliance- focused agenda is incorporated into the practice of interactive surveillance by pretrial officers who use GPS in accordance with the traditions in which they have been trained, as favored by the agencies where they are employed. These traditions animate and legitimize the varying approaches to, or “styles” of, interactive surveillance that are observed in action. Because these styles reflect varying methods and philosophies of community corrections, we first address how supervision has been conceptualized in the literature and review prior research on supervision utilizing EM technology, before examining interactive surveillance in three U.S.-based GPS for DV pretrial programs.

Literature review

Progressive Journal Part 1 & 2 Also Discussion Board 2

June 17, 2023/in Uncategorized /by SK

There are 2 PARTS to this assignment. Part 1 has to be incorporated into PART 2 it has to be 500-800 words. See attachments. Also there is a discussion board down below!!

There have been several postings of pregnant Hollywood stars (Britney Spears, Denise Richards, Victoria Beckham) who have scheduled C-sections for convenience and to avoid the pain of childbirth. Discuss this option in terms of women’s rights, and health care coverage (typically C-sections are only covered if they are medically necessary).

This discussion is meant to reflect your personal opinions, not textbook language or theories. These questions are meant to stimulate your thinking. Since the Discussion Board is viewable by others, please do not share thoughts that you would not want others to know.

For this discussion, post one Thread in which you answer the following questions. You are expected to write full paragraphs and give specific examples as part of your answers. A short 2-3 sentence answer is NOT sufficient to earn full credit. Then Reply to at least 3-4 other students’ Threads. Write 3-4 sentences or more in each Reply explaining your thoughts.

PSY-241 (Fall 2018)

Progressive Journal 1

Part 1: Preliminary Portion

Before completing the written portion of the journal assignment, you must complete the preliminary portion. During the preliminary portion, you will identify specific characteristics of your “person”. This will be completed in class by rolling dice. Students who are absent will be responsible for determining the characteristics of their “people” outside of the classroom.

Instructions:

Roll one die one time for each set of characteristics listed below. Your “person” will have the characteristics for the corresponding numbers listed.

Characteristics:

1. Gender

a. If you roll 1, 3, or 5 your person is MALE

b. If you roll 2, 4, or 6 your person is FEMALE

2. Racial/Ethnic Group

a. If you roll 1 or 3 your person is CAUCASIAN

b. If you roll 2 or 5 your person is AFRICAN-AMERICAN

c. If you roll 4 your person is ASIAN

d. If you roll 6 your person is HISPANIC

3. Parents’ Age Range (the age range applies to both parents)

a. If you roll 3 or 5 the parents of your person are 17 or younger

b. If you roll 1 or 4 the parents of your person are 18-40

c. If you roll 2 or 6 the parents of your person are over 40

4. Marital Status (If “married”, parents live together; if “single”, parents live in separate households)

a. If you roll 1, 3, or 5 the parents of your person are MARRIED

b. If you roll 2, 4 or 6, the parents of your person are SINGLE

5. Number of Siblings

a. If you roll 1 your person has NO SIBLINGS

b. If you roll 2 or 6 your person has 1 SIBLING THAT IS NOT A TWIN

c. If you roll 3 your person has 1 SIBLING THAT IS A TWIN

d. If you roll 4 your person has 2 OR MORE SIBLINGS

e. If you roll 5 your person has 2 OR MORE SIBLINGS, ONE IS A TWIN

6. Parents’ Education Level (**NOTE: If the parents are 17 or younger, you can ONLY roll “not completed high school” or “completed high school, no college.” If you get a number that does not correspond with those choices, roll again. Education level applies to both parents.)

a. If you roll 1 the parents of your person have NOT COMPLETED HIGH SCHOOL

b. If you roll 2 the parents of your person COMPLETED HIGH SCHOOL, NO COLLEGE

c. If you roll 3 or 4 the parents of your person COMPLETED SOME COLLEGE, NO DEGREE

d. If you roll 5 the parents of your person COMPLETED COLLEGE

e. If you roll 5 the parents of your person COMPLETED GRADUATE DEGREES

7. Financial Status (**NOTE: If the parents have either not completed high school or only completed high school with no college, they can only roll a 1, 2, or 3. If you get a number that does not correspond with those choices, roll again. Financial status applies to parents’ combined income, whether parents are married or single.)

a. If you roll 1 the parents of your person are SIGNIFICANTLY BELOW THE POVERTY LEVEL

b. If you roll 2 the parents of your person are JUST BELOW THE POVERTY LEVEL

c. If you roll 3 the parents of your person are SLIGHTLY ABOVE THE POVERTY LEVEL

d. If you roll 4 or 5 the parents of your person are ABOVE THE POVERTY LEVEL

e. If you roll 6 the parents of your person are WELL ABOVE THE POVERTY LEVEL

8. Do the parents smoke? (**NOTE: If parents smoke, both parents smoked during pregnancy and around the infant.)

a. If you roll 1, 3, 4 or 5 the parents of your person DO NOT SMOKE

b. If you roll 2 or 6 the parents of your person DO SMOKE

Vargas Family Case Study: Eighth Session

June 17, 2023/in Uncategorized /by SK

Read the entire “Vargas Family Case Study” (all eight sections). Consider the progress (or lack thereof) over the past eight sessions. Using the “Discharge Summary Outline” template; include the following in your outline:

A brief summary of what was going on with the family
A review of the initial treatment goals
Theories and interventions used
A brief discharge summary for the family treatment
Clinical recommendations for sustained improvement or referrals for additional services

Vargas Case Study

Vargas Case Study: Topic 1

Bob and Elizabeth Vargas have been married for 10 years. They have two children, Frank (8) and Heidi (6). Bob teaches high school PE and coaches football, wrestling, and baseball. Elizabeth recently quit her job where she was an attorney in a law firm that specializes in Family Law. She enjoyed her work, had a passion for adoption cases, but decided to stay home for a few years while the kids were young. Elizabeth believes that Frank might have ADHD. She complains that he cannot sit still, does not listen, is forgetful, and is always getting hurt. She believes that much of these injuries are due to Frank’s impulsivity. Elizabeth suggests you talk to Frank’s teachers who have noticed that he has trouble waiting his turn, will often blurt out answers without raising his hand, and frequently loses things. Elizabeth acknowledges that Frank has always been an active child, but believes these behaviors, including picking on his little sister, are getting worse. Bob seems to be amused by these anecdotes and accuses Elizabeth of “overreacting,” stating that, “Boys will be boys.” Bob suggests you talk to his parents, both retired teachers, who agree with him and don’t think there’s anything wrong with Frankie. You notice Heidi sitting close to Elizabeth, playing on her mother’s cell phone. She glances up occasionally when her brother approaches, but is otherwise engrossed with the game. Frankie began the meeting sitting between his parents, but noticed Legos in the corner and was immediately attracted to them. He interrupts several times to share stories about his teacher, classmates, and his grandparents, despite numerous reprimands from his mother. After a few minutes, Frank asks to use his Dad’s phone (in a hurry, Bob had left it in the car), wanders around the office, looks out the window and comments on a squirrel, then grabs the phone from his sister who, of course, protests. After Elizabeth had quieted the commotion, you question any recent changes. Bob and Elizabeth both acknowledge an increase in marital tension and admit to having several arguments a week, some in front of the children. Bob blames Elizabeth for being “too high-strung” and says she just needs to relax. Elizabeth says she is unable to relax, fearing Frankie will end up damaging things or hurting himself or Heidi. She says that if Frankie would be able to control his behaviors, their marriage would improve dramatically. This, they report, is the reason for seeking therapy for Frankie.

Vargas Case Study: Topic 2

Elizabeth arrives on time with Frank and Heidi for the second session. Elizabeth appears somewhat frazzled and tells you that she had just heard from Bob who said he would be “a little late” because he “lost track of time.” You note Elizabeth’s frustration, which she confirms by saying this is “typical.” She proceeds to share that she feels “completely disregarded,” especially after having shared with Bob the night before how important these sessions are to her. You notice that Heidi seems upset as well and looks as if she has been crying. You ask her how her day is going and she tearfully tells you that Frankie tore up her school paper with the gold star on it. Elizabeth elaborates that Frank had become angry and ripped up the picture that Heidi was proudly sharing with her. Frank, who had gone directly to the Legos, appears oblivious to the others in the room. When you ask him about his sister’s sadness, he replies, “Who cares? She always gets gold stars!”

As you were about to further explore these feelings, Bob arrives stating, “She probably told you I’m always late, but hey, at least I’m consistent.” You notice Elizabeth’s eye rolling and direct your attention to the children, asking them about what brought them to your office. Heidi says, “I’m good but Frankie’s bad at school, and it makes Mommy and Daddy fight.” Frank, who had helped himself to one of your books to use as a car ramp argues, “I hate school. It’s boring and my teacher is mean.” Bob attributes Frank’s boredom to being “too smart for the second grade…what do they expect?” Elizabeth responds that they, like her, expect him to follow rules and be respectful, and suggests that Bob should share those same expectations. Bob dismisses Elizabeth’s concerns by saying, “He’s a normal boy, not like all your friends from work who you say are ‘creative.’”

You notice Elizabeth’s reaction and decide to redirect your attention to Frank. You ask him what bothers him most about school, to which he replies, “I get in trouble, then I don’t get to have all the recess time, then I can’t play soccer because they already started and they won’t let me play.” You notice Frank’s interest in sports and probe for more information. You learn that he is quite athletic and has been asked to join a competitive youth soccer team that plays on Saturdays and Sundays. You discover another source of discord when Elizabeth shares that Bob “feels strongly” that Sundays are to be spent only at church and with family. Bob confirms that after church on Sundays, they spend the rest of the day with his parents, siblings, nieces, and nephews. Elizabeth says that Sunday mornings are the only time she gets to be by herself and that she typically joins the family around 1:00 p.m. Bob adds, “Apparently Liz needs time to herself more than she needs God and her family,” and suggests she should appreciate his family more because “it’s the only family she has.”

As the session comes to a close, you share your observations of the family by noting their common goal of wanting to enjoy family time together. You also suggest that while Frank’s behavior challenges are troubling, perhaps you could focus next week on learning more about each parent’s family of origin in hopes of gaining a better understanding of the couple’s relationship.

Vargas Case Study: Topic 3

Bob and Elizabeth arrive together for the third session. As planned, you remind the couple that the goal of today’s session is to gather information about their families of origin. Bob begins by telling you about his older sister, Katie, who is 36 and lives nearby with her three children. Katie’s husband, Steve, died suddenly last year at the age of 40 when the car he was driving hit a block wall. Elizabeth speculates that Steve was intoxicated at the time, but Bob vehemently denies this allegation. He warns Elizabeth to “never again” suggest alcohol was involved. You note Bob’s strong response and learn that his own biological father, whom his mother divorced when Bob was three and Katie was five, had been an alcoholic. When asked about his father, Bob says, “His name is Tim, and I haven’t seen him since the divorce.” Bob shares that he only remembers frequently hiding under the bed with Katie to stay safe from his violent rages. He adds that 5 years after the divorce, his mother, Linda, married Noel who has been “the only dad I’ve ever known.” He insists that his sister married “a devout Christian who never touched alcohol” and attributed the 3:00 a.m. tragedy to fatigue. He adds that a few days before the accident, Katie had complained to him that her husband had been working many late nights and “just wasn’t himself.” Bob speaks fondly of his sister and confirms that they have always been “very close.”

From Elizabeth, who is 31 years old, you learn that she was adopted by her parents, Rita and Gary, who were in their late 40s at the time. They were first generation immigrants who had no family in the United States. Their biological daughter, Susan, had died 10 years earlier after Rita accidentally ran over the 5-year-old while backing out of the driveway. Elizabeth surmises that her mother never fully recovered from this traumatic incident and remained distant and withdrawn throughout Elizabeth’s life. Elizabeth describes her father, Gary, as “a hard worker, smart, and always serious.” She shares that most of her family memories were of times spent with her dad in his study, surrounded by books. She states, “He could find the answer to all of my questions in one his many books.” Elizabeth describes herself as the “quiet, bookish type” and attributes her love for books to her father. Like her father in his study, Elizabeth remembers spending most of her adolescence alone in her room, reading, so she would not upset her mother. Looking back, Elizabeth tells you she recognizes her mother’s struggle with depression, “but as a kid, I thought it was me.”

You comment on the vastly different childhood experiences and normalize the potential for relationship challenges under these circumstances. Acknowledging the differences, Elizabeth remarks that Bob’s relationship with his family was one of the things that she was attracted to early in their relationship. Bob agrees with her and comments that Katie and Elizabeth are very close, “each being the sister neither one of them ever had.”

Vargas Case Study: Topic 4

The Vargas family arrives for the fourth session at separate times. You have been chatting with Elizabeth and Heidi about Frank’s recent school suspension when Bob and Frank enter. They are having an animated conversation, laughing hysterically, and Heidi comments on how Frank is wearing socks, not the rain boots he left the house in. Bob and Frank proceed to share the story about how Frank’s top scoop of ice cream just fell into his boot when Elizabeth interrupts. She questions Bob and appears surprised to learn that instead of going to work with Bob who had agreed to “put him to work” as a consequence of his suspension, the two of them had spent the day having fun. Frank talks about his new bike and had begun a story about the movie they saw when he looks at his dad and instantly stops talking. You notice Bob’s stern look when Frank apologizes stating, “I forgot I’m not supposed to tell.”

The tense silence is broken by Heidi who begins to tell her parents that she got another gold star on her spelling test, the teacher picked her to be the helper, she scored two soccer goals at recess, and made three new friends. You notice that Frank has squeezed into the same chair next to Bob; Heidi scoots closer to her mother on the couch. You note Elizabeth’s distress and invite Bob to comment. Bob minimizes the incident that resulted in Frank’s suspension and accuses Elizabeth of “overreacting.” Frank agrees that “Mom always gets mad” and begins recounting the “funny” incident that was, according to him and Bob, “no big deal.”

Vargas Case Study: Topic 5

The Vargas family arrives to their fifth session together and on time. As a follow-up to the last session’s focus on the family structure, you decide to consider a strategic approach this week. To check in, you invite them to share any feedback from last week’s session. Bob reports that he apologized to Elizabeth for “mishandling the suspension thing” then complains that Elizabeth is still “holding a grudge.” He admits that he often does not understand why she gets so upset and that he wants her to be happy. Elizabeth acknowledges that the apology “is a start” and suggests that the reason Bob doesn’t understand is that he “doesn’t ever listen” to her. Bob tells Elizabeth that he listens, but gets frustrated because he doesn’t know how to “fix it.”

You notice Frank and Heidi sitting together, quietly looking at a book while their parents talk. You inquire about any noticeable changes made during the week. Both parents claim to have made an effort to avoid raising his/her voice and report being pleased with their conduct. When asked about the children, Elizabeth reports noticing improvement. Bob, however, expresses frustration with Frank’s constant need of redirection and numerous reminders to complete his chores. Bob also noted an increase in Heidi’s demands for attention.

Vargas Case Study: Topic Six

The Vargas family arrives five minutes late for their sixth session. Elizabeth apologizes for their tardiness and complains that they had come from an event hosted by her former employer and were having an argument in the parking lot. You notice the children appear somewhat disheveled with red cheeks and grass-stained clothing. They excitedly share stories of coming from a “big picnic” where they “played lots of games and made new friends.” Frank tells you that he was playing Kick Ball and that his team was winning. Smiling and tousling Frank’s hair, Bob adds that he and Frank were “an unstoppable force” who dominated each event at the picnic. Bob and Frank were in the middle of a celebratory high-five when Heidi tells her dad that she wishes he would have been on her soccer team. While still engaged in the celebration with Frank, Bob replies, “Me too; maybe next time.”

Elizabeth states she was “pleasantly surprised” that Bob was enjoying himself, given his strong personal opinion of many of her friends, who are gay. Bob insists that the picnic was “just okay,” and that he “was just trying to be nice.” He tells you he doesn’t have “anything against gays,” but that “they just make me uncomfortable.” Heidi reminds him that he agreed to have her new friend, Dani “and her two daddies,” over for a barbeque. You comment that the family’s mood has changed from how they arrived. Frank explains that his mother got angry at him and admits to running away and hiding from his mother when she said it was time to leave the picnic. Elizabeth immediately denies being mad at him. You ask Frank what made him think his mother was mad, and he replied, “Her eyes were squinty and she had a mean voice.” When asked if his dad was also angry, Frank replies, “He saw me in my hiding place; he was smiling. Then in the car, he yelled at me to ‘listen to your mother.’”

Elizabeth shot Bob an angry look when Heidi shares that she was having fun playing soccer and that she didn’t want to leave either. She adds, “I always listen because I don’t want Mommy to be sad.” She proceeds to blame her brother for “making Mommy and Daddy fight” to which Frank makes a counter-accusation, blaming Heidi for the parental discord. Elizabeth and Bob exchange angry looks, then Bob assures Heidi that, “It wasn’t all your fault.”

Vargas Case Study: Topic 7

Since the last session, you received a call from Elizabeth who stated her family was in crisis. She reported that her nephew Geoff, the 15-year-old stepson of Bob’s sister, Katie, had nearly overdosed. She said that the family had noticed some changes with Geoff since his father’s recent death, but attributed the poor mood and slipping grades to the normal effects of grief. Elizabeth said that Geoff had never used drugs, as far as anybody in the family knew, and that the overdose was “a total surprise.” Elizabeth reported that after learning of this, Bob’s mother, Linda, called the school counselor but complained to Katie that “she was not at all helpful,” and told Katie exactly how she should handle it. Katie spoke with the school counselor who told her that she was not allowed to speak with Linda due to matters of confidentiality. Elizabeth informed you that Katie had shared her frustration with the school counselor’s suggestions to help him “get his mind off the sadness,” and believed he needed more help. You learned that Bob’s father, Tim, was trying his best to help, and that Elizabeth felt his intrusion was making matters worse. Among other things, Tim had taken Geoff out of school on a week-long camping trip against Katie’s wishes. Elizabeth said that the involvement of Linda and Tim, despite their good intentions, had begun to cause widespread family strife and asked if you could possibly see the entire family.

Vargas Case Study: Topic 8

This session with the Vargas family includes Elizabeth, Bob, Frank, and Heidi. You begin by inviting Bob and Elizabeth to sit together on the couch and follow up on the events described to you in the phone call with Elizabeth You learn that there are ongoing concerns regarding Geoff’s safety, as well as with maintaining boundaries with their extended family members. Elizabeth tells you that Bob “had strong words” with his parents, who were initially quite upset. Bob confirms this and states that despite the difficulty, “they need to butt out.” You validate Bob’s struggle and reframe this as bravery. You note the family’s willingness to seek help as a significant strength. Bob expresses concern for his sister having recently lost her husband and nearly losing her son. He shares how unfortunate it is that something bad had to happen to help him realize how fortunate he is. Bob states that he admires his sister’s strength, and becomes tearful as he tells Elizabeth that he cannot imagine what it would be like to lose her. He expresses belief that it would be “impossible” for him to be a single parent and tells his wife that he realizes he has been taking her for granted. Elizabeth receives these words with quiet gratitude, providing comfort, being sensitive to Bob’s vulnerability. Bob wipes his tears and apologizes for what he calls “falling apart.” You notice Frank and Heidi settle in closer to their parents. Eventually, the therapeutic silence is broken when Frank hands his dad a tissue and says, “It’s okay for boys to cry. Mom says so.”

© 2015. Grand Canyon University. All Rights Reserved.

© 2018. Grand Canyon University. All Rights Reserved.