Application of Attachment Theory to a Case Study

 

• Review the same case study you selected from last week’s Assignment. 
• Use the Analysis of a Theory Worksheet to help you dissect the theory. Use this tool to dissect the theory and employ the information in the table to complete your Assignment.
• Review attachment theory and the following article listed in the Learning Resources: Foley, M., Nash, M., & Munford, R. (2009). Bringing practice into theory: Reflective practice and attachment theory. Aotearoa New Zealand Social Work Review, 21(1–2), 39–47. https://doi.org/10.11157/anzswj-vol21iss1-2id318

 Write the assumptions of attachment theory.Identify the problem in your chosen case study to be worked on from an attachment theory perspective.Explain how attachment theory defines and explains the cause of the problem.Develop two assessment questions that are guided by attachment theory that you would ask the client to understand how the stress or distress, bond, and/or environment is affecting the client.Identify two interventions to address the problem. Remember, the theory should be driving the interventions. In other words, you would not identify systematic desensitization since this is not an intervention guided by attachment theory.Write one self-reflective question that is influenced by attachment theory that you can ask yourself to gain greater empathy for what the client is experiencing.

 

Submit also, as a separate document, your Week 3 Analysis of a Theory Worksheet.

Be sure to:

ISSUES 1 AND 2, 2009 AOTEAROA NEW ZEALAND SOCIAL WORK PAGE 39

Bringing practice into theory:
Reflective practice and attachment
theory
Maree Foley, Mary Nash and Robyn Munford

Maree Foley is a PhD candidate in the Department of Management and International Business at
the University of Auckland Business School, a NZ Registered Psychotherapist and full member of
NZACAP.

Mary Nash is a Life Member of ANZASW and lectures at Massey University.

Robyn Munford is co-leader of a FRST-funded research project on young people’s pathways to resil-
ience and works in the School of Health and Social Services, Massey University.

Abstract

The relationship between social work practice and attachment theory has been longstand-
ing across decades. While much attention has been paid to the use of attachment theory
within specific social work practice settings, less attention has been focused on the use of
attachment theory to guide the social worker in their practice based reflections. This article
explores the potential relevance of attachment theory for use within a reflective practice set-
ting. This exploration is based on key findings from a recent study conducted in Aotearoa
New Zealand. A proposed beginning framework of attachment theory informed reflective
practice is offered for practitioners to explore in their reflective practice.

Introduction

Exploration of the relationship between theory and practice has been a longstanding endea-
vour within many disciplines including social work (Longhofer & Floersch, 2004; D’Cruz,
Gillingham, & Melendez, 2007, p.74). This paper explores the use of attachment theory to
inform reflective practice and, in turn, to potentially inform social work practice. This explo-
ration is based on a recent Aotearoa New Zealand Masters research study that explored the
relationship between theory and practice, from the vantage point of the social worker (Foley,
2007). This paper begins by providing a brief overview of this study, including a review of
current attachment theory literature for social work practitioner use. Next, a summary of
the study’s findings is reported.

The remainder of this paper attends to the authors’ reflections on how the raw findings
might usefully inform reflective practice. It is postulated that knowledge of attachment
theory can be useful for the practitioner to increase understanding of both shared and unique
protective and adaptive behaviours within a practice setting where their capacity to think,
reflect and make meaningful connections may become compromised. Based on these postu-

PAGE 40 AOTEAROA NEW ZEALAND SOCIAL WORK ISSUES 1 AND 2, 2009

lations, an exploration of bringing key dynamics of social work practice with children and
families into attachment theory is explored. This exploration is followed by the beginning
formulations of an attachment theory informed reflective social work practice.

Overview of the study

This study began with a review of the literature on attachment theory and social work prac-
tice, where it was clear that interest in attachment theory as a relevant social work practice
theory has been sustained over a number of decades (Bowlby 1969, 1973 and 1980; Ainsworth
& Bowlby, 1991; Cassidy and Shaver, 1999). As such a plethora of relevant literature for this
study was found (Fahlberg, 1991; Howe, 2005; Howe, Brandon, Hinings & Schofield, 1999;
Nash, Munford, & O’Donoghue, 2005; Atwool, 2006). Surprisingly, studies that investigated
social work practitioners’ knowledge of attachment theory to inform their practice, found
that attachment theory knowledge was not as prominent as expected (Hesse, 1982; Grigsby,
1994; Hendemark, 2004). In addition, recommendations from these social work practice
specific studies each implied a view that advocating for increased attachment theory ori-
ented education would equate with the capacity to use this theory in practice. As such there
seemed to be an underlying assumption within the recommendations of these studies that
theoretical knowledge equates with use, and use amidst the real time and moments of the
social work-client relationship.

Given the above paradoxical findings above, Foley (2007) conducted a study that
sought to gather Aotearoa New Zealand data regarding the practice status of attachment
theory and research developments as experienced by social workers within their social
work practice with children and their families. While keeping in mind socio-cultural-
contextual issues, the primary focus of this study was the microsphere of practice. This
study endeavoured to understand the journey of a theory, attachment theory, through
the vehicle of the social worker in their practice descriptions of using attachment theory
to inform their practice.

In this qualitative phenomenological study (Van Manen, 1990), eight social workers who

self-identified as being interested in and knowledgeable about attachment theory were in-
terviewed and were invited to reflect on their experiences of putting attachment theory into
social work practice with children and families. One of the interview questions included:
‘What aspects of attachment theory have made the most sense to you as a social worker?’
That is, most of the social workers in this study began their reflections not with accounts of
attachment theory knowledge, but with their own responses to the theory.

Following these interviews, an analysis process (Colaizzi,1978; van Manen, 1990) en-
sued, guided by a key question: ‘Are there identifiable patterns, implicit and or explicit,
being used by the interviewed social workers in their processing of attachment theory
as a social work practice theory, to inform child and family oriented social work?’ The
initial analysis focused on ascertaining from the descriptions an anticipated pattern of
‘putting theory into practice’. However, the descriptions of these social workers in this
study did not fit this pattern. Instead a different pattern was identified: That is, when
the participants’ responses were analysed, the self of the practitioner along with practice
knowledge preceded any theoretical comment, reflecting a process more akin to ‘Bringing
practice into theory’(Foley, 2007).

ISSUES 1 AND 2, 2009 AOTEAROA NEW ZEALAND SOCIAL WORK PAGE 41

As the coded analysis continued, a general pattern emerged where it appeared that each
social worker was bringing their experience of attachment theory along with their under-
standings to their practice. In turn, bringing social work practice into attachment theory
became understood to represent a process where neither practice nor theory was privileged.
Instead, privileged was the social worker. It was this finding that largely informed a key
recommendation of this study:

Attachment theory as a relational theory requires a broadening of the potential scope of rel-
evance within attachment theory informed social work practice theory to be inclusive of the
social worker, the client and the social worker-client relationship (Foley, 2007, p. 138).

In addition, the attachment theory foundations prominent in this study were consid-
ered a useful theoretical framework to support re-positioning of the social worker to
the centre of the theory – practice dance. As such, this paper returns to the relevant
literature of this study but with a different purpose in mind: to view attachment theory
as being potentially useful to inform the social worker about themselves and their
relationships; and for this exploration to be supported and developed in a reflective
practice structure.

Re-viewing attachment theory for practitioner use

While there are many comprehensive reviews of attachment theory across disciplines
(Cassidy & Shaver, 1999) within social work, attachment theory is commonly identi-
fied as most relevant to specific fields of practice such as the care and protection needs
of infants and young children (Howe, 2005; Schofield & Beek, 2006). While attachment
theory is often associated with infants and young children, current studies have sought to
examine the activation of the attachment system in adulthood at times of stress/distress
(Mikulincer, Birnbaum, Woddies & Nachmias, 2000; Mikulincer, Gillath & Shaver, 2002).
That is, to explore whether adults continue to seek out a significant other (someone in a
caregiving role) at times of high stress, with the goal of that other providing relief and
support that in turn facilitates exploration of possible problem-solving routes. It has been
repeatedly found that under stress all adult participants ‘underwent preconscious activa-
tion of the attachment system’ (Mikulincer & Shaver, 2003, p. 89). These findings highlight
that the attachment system is relevant throughout the life span and optimally viewed in
relationship to and with two other interdependent systems: the caregiver system and the
exploratory system.

Central to these stress/distress-based understandings within attachment theory is the
construct of ‘the secure base’ (Bowlby, 1988; Schofield & Beek, 2005). In attachment theory,
an experience of ‘felt security’(Sroufe & Waters, 1977, p. 1186) increases the capacity to ex-
perience stress without being overwhelmed. In turn ‘felt security’encouraged exploration
at difficult times, it kept problem solving mobile, creative and relational. Bowlby proposed
that when ‘felt security’at times of stress was compromised then one way to create security
was to become self protective through using processes of the mind referred to as ‘defensive
exclusion’ and/or ‘selective exclusion’ (Bowlby, 1980, p. 52). As a consequence of these
mind processes, aspects of experience could be excluded from awareness and therefore not
as readily available to remember, share and/or prompt help seeking to resolve the stress
which was being experienced.

PAGE 42 AOTEAROA NEW ZEALAND SOCIAL WORK ISSUES 1 AND 2, 2009

Central to the development of attachment theory has been the development of the hy-
pothesis that repeated experiences of the attachment-caregiving and exploratory system
become internalised as implicit mental maps of how relationships when under stress best
function. These maps, referred to as ‘internal working models’, are open to adaptation and
change yet often remain unchanged in structure across generations (Cassidy & Shaver, 1999).
It is thought that the greater opportunity for felt security on offer from the caregiver system
at times of high need/stress, the more open, dynamic and creative the exploratory system
can remain for problem solving. In contrast, when ‘felt security’ is compromised in some
way, it is more likely as Bretherton (1985) stated that if ‘material is defensively excluded
from awareness, it cannot be restructured or updated…’(p. 13).

Therefore attachment theory infers that in the presence of ongoing stress within the at-
tachment-caregiver and exploratory systems, a working model exists of how relationships
function when stress develops. In turn, this implicit model includes experiences and expecta-
tions of self concerning one’s capacity to seek out and make use of help and support at the
times it is most needed. Included also are experiences and expectations of how others are
likely to respond to requests for help and support. For example, information can become
repeatedly excluded for the purpose of self-protection from unbearable pain. The more infor-
mation is excluded from attention and processing, the less responsive a person can become
to considering new information that does not fit the current view of their relationships.

In summary, attachment theory advocates that at times of overwhelming stress/pressure,
our capacity to experience stress/pressure and be able to think and act in ways to reduce
the stress/pressure is related to the quality of the relationship that we have, or can in the
present establish, with a secure base. In turn attachment theory asserts that the quality of
relationship made possible with the sought-after secure base is influenced by the internal
working model of relationships and the type of exclusion/inclusion defences activated to
protect against any expected suffering specific to attachment-caregiving experiences. In
addition the experience with the secure base at times of high stress impacts on the capacity
and content possibilities of reflection.

Bringing social work practice into attachment theory

Social work with children and families is often conducted amidst high anxiety, uncertainty
and emotion. Within this emotional context, the social worker is both ethically and profes-
sionally responsible to reflect, think and act with coherence. However, Fonagy, Steele and
Steele (1991) assert that ‘day-in, day-out, social workers (and their agencies) practise in
emotionally demanding environments which trigger characteristic coping styles, defensive
strategies and adaptive behaviours’ (p. 205).

In addition, in a social work setting, the nature of social work service provision often
structures the social worker-client relationship with the social worker in the helper/help
provider role and the client in the helpee/help seeking role. Therefore, regardless of the
social work field of practice, when a context of stress/pressure is recognised for the social
worker and or the client, attachment theory can be relevant in understanding the follow-
ing. First, unique responses of the social worker and the client to distress-stress; second,
the impact of these responses on the capacity of the social worker and the client to reflect
on and then become exploratory towards possible solutions; and third the social worker’s

ISSUES 1 AND 2, 2009 AOTEAROA NEW ZEALAND SOCIAL WORK PAGE 43

practice capacity to enact the social work plan along with the client’s capacity to experience
being helped and supported.

In a social work relationship it is often the social worker who is working with the client
to co-construct a secure base within the client’s family and community. At best a secure
base is where the conditions for ongoing experiences of ‘felt security’are on offer. Within
an attachment theory informed social worker-client relationship, it is the task of the social
worker, in the role of helper to assess and, where possible, structure conditions for the client
that will optimally provide the conditions for the client to experience ‘felt security’.

While in principle it is easy to concur with the global social work goals of providing
help, support and the conditions for felt security for clients, most social workers will have
stories and experiences where help offered to another in need is rejected, not made use of,
fought against. We know from practice that while some clients who meet the criteria for
high needs, who have multiple needs, who concur with the social worker that they need
help are also at times the most challenging to a social worker’s sense of efficacy. Failure, fear
and hopelessness can quickly overshadow the original quest to provide/offer social work
service. In addition, some of these very clients with high needs, can also be the clients who
are the most difficult to listen to and to spend time with. A social worker may feel embar-
rassed, ashamed, private about their own practice responses to these clients. For example,
a social worker who wishes to provide help and support may repeatedly find themselves
at work acting in ways that are unresponsive, inconsistent, avoiding responding to phone
calls and dismissing or minimising a family’s needs.

Recent social work practice research by Ruch (2005a; 2005b; 2007) advocates that for social
workers to engage in best practice, social workers need organisational support to develop
their reflective capacities. Ruch (2007) proposes one way to support social workers in this
endeavour is to step up the secure base that their respective practice agencies offer to social
workers to support them in their practice. Therefore, by increasing organisational support,
a social worker is more likely to experience felt security within their organisation, in turn,
increasing a social worker’s reflective capacities (Ruch, 2005b, p. 111).

Attachment theory can further develop this proposition. Attachment theory can be useful
to guide the reflection process concerning relationships that are functioning within stress-
ful/overwhelming experiences/situations, and where these relationships reflect a helpee-
helper dynamic. As such attachment theory could be used to inform reflective practice, the
place where it is commonly agreed social workers bring themselves and their practice into
view, for theoretical and practical review, often within a supervisory relationship.

Bringing the social work practitioner into attachment theory: Reflective
practice

In addition to the original understandings espoused by Bowlby (1969; 1973; 1980), Ainsworth
and Bowlby (1991) plus the recent work on adult attachment (Mikulincer & Shaver, 2003) three
useful constructs have emerged from attachment theory research that have direct relevance
to reflective social work practice: ‘Coherence’(Main 1991); ‘reflective functioning’(Fonagy
et al., 1991) and ‘mind-mindedness’ (Meins, Fernyhough, Fradley & Turkey, 2001). While
there is not the space to delve into each of these constructs, they each extend an assump-

PAGE 44 AOTEAROA NEW ZEALAND SOCIAL WORK ISSUES 1 AND 2, 2009

tion in attachment theory: That what is held in mind of a relationship functions to guide
what can be observed, acknowledged, and attended to in a way that provides the security
seeker with relief.

As such, based on the theoretical exploration above, for a social worker in a caregiver,
helper role, it is possible to hypothesise from an attachment theory perspective, that what
is available for reflection, and the degree of relational capacity that can be sustained while
reflecting, in turn impacts on the social worker’s capacity to provide ‘sensitive responding’
(Ainsworth, Blehar, Waters & Wall, 1978) to their client. That is to attune, to interpret and
to respond within the client’s time frame. Bowlby’s constructs of selective and defensive
exclusion, referred to above, function to self protect from experiencing affects and thoughts
that are perceived as overwhelming and unbearable. As a consequence this impacts on what
is available to be reflected on. Therefore, attachment theory does not assume that what we
report, and have immediate access to for reflection, is all that there potentially is to reflect
on. It assumes instead, that by increasing our capacity for ‘reflective functioning’(Fonagy
et al., 1991) and ‘mind-mindedness’(Meins et al., 2001) we will come to know much more
of what is there to be known within the helper-helpee relationship.

A working model of attachment theory informed reflective social work practice

While social work has a strong tradition of reflective models of social work practice (for
example see: Redmond, 2004; Ruch, 2005a and 2005b), attachment theory provides a lens in
which to view the reflective process itself and to gain greater understanding and empathy
for what each social worker within each unique social work-client relationship can access
of that relationship for reflection.

What follows is the beginning formulations of an attachment theory informed framework
for reflective practice. Central to this formulation are two key attachment theory constructs:
the attachment-caregiver and exploratory systems and the secure base. These key constructs
in turn can inform the development of guiding questions for use within a reflective prac-
tice setting. As such, it is suggested here that the following needs consideration: the social
worker’s internal working model; how the social worker functions in the presence of intense
affect and stress and how they relate to others when in a helper-caregiving role; knowledge
about defensive exclusion strategies used, when they are used and with whom.

For the purposes of an attachment theory model of reflective practice:

Knowledge of self becomes inclusive of knowing how one feels, thinks and acts when stressed
and when needing to be in a help provider role at this time. To develop attachment theory
informed questions that are structured so that at all times the challenge to think and act in a
relational way is present (Foley, 2007, p. 146).

A working example is presented in the diagram below: Secure-base reflective questions.
This diagram has been developed from drawing on the work of Zeanah, Boris, Scott Heller,
Hinshaw-Fuselier, Larrieu, Lewis, Palomino et al. (1997), who during infant-parent assess-
ments keep in mind a key question throughout the process. That is: ‘what it feels like to
be this particular infant in this particular relationship with this particular caregiver at this
particular time’ (p. 186). The study showed it is possible to extend and adapt this key ques-
tion to assist reflective practice concerning social worker-client relationships.

ISSUES 1 AND 2, 2009 AOTEAROA NEW ZEALAND SOCIAL WORK PAGE 45

For example, the diagram below portrays a refl ective circle posing a number of questions,
with the social worker taking in turn the position of the key relationships, and refl ecting on
what it is like to be in this position in relationship with self and others. These formulated
questions are not intended to be exhaustive nor necessarily representative of all key rela-
tionships. They are but as working examples in which to begin to anchor the social worker
in considering the interplay of multiple attachment-caregiver-exploratory systems within
a single social work interaction.

Figure one. Secure-base refl ective questions (Foley, 2007, p. 147).

PAGE 46 AOTEAROA NEW ZEALAND SOCIAL WORK ISSUES 1 AND 2, 2009

In addition it is suggested that following reflection on social worker-client experiences, that
an attachment theory-informed framework of reflective practice include reflections on how
to ensure as best as possible an experience of ‘felt security’for both the social worker and the
family as a precursor to any social work intervention. As such the following questions were
formulated within the study as a guide to provide further relational support to the social
worker and the family as an integral aspect of any other social work. The following practice
based attachment theory informed questions are represented below in Table one.

Table one. Practice based attachment theory informed questions (Foley, 2007, p.148).

1. Based on what I have understood about the internal working model of help seeking-provision of
this client/client family, what do I need to offer this client/client family to provide the conditions
for them to have an experience of ‘felt security’? What support might they need to optimally feel
safe in receiving help and support?

2. What does the client/family need to offer to their own family, so as to provide the conditions for
their own family to have an experience of ‘felt security’? What support and/or systems would
optimally provide the conditions for the family to experience efficacy and family belonging/mem-
bership.

3. Based on what I know of my own internal working model of help seeking-provision, what do
I need to be offered and receive from my team/colleagues for me to have an experience of ‘felt
security’, so I can help this client/client family?

4, What other key relationships and social resources might I consider as being useful to have on offer
for this client family so as to provide further conditions for ‘felt security’?

Conclusion

In conclusion, while attachment theory and social work have shared a longstanding relation-
ship, the potential for social workers to use attachment theory for their own personal and
professional development has been explored here. Highlighting the attachment-caregiver
and exploratory system in relationship to the secure base and relating this to the social
worker-client relationship, extends the potential use of attachment theory to any social work
interaction functioning in a context of stress and/or distress. The above suggestions of how
one might include these theoretical underpinnings into a reflective practice setting are the
reflective fruit of research-based conversations with the social work participants who were
generous enough to share their practice into theory approaches at work.

References

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Worksheet: Dissecting a Theory and Its Application to a Case Study

Most theories can be dissected and analyzed. All theories will tell you something about their focus or unit of analysis. A theory will identify its major or key concepts. It will also point to the definition of the problem and its cause. This then guides how the social worker assesses and intervenes because the theory will also articulate the role of the social worker and how change occurs.

Basic Assumptions of the Theory

Directions: For each section, respond in 2 to 3 sentences to the following prompts. Where relevant, provide citations to support your claims.

Name of theory: Systems theory

Name of theorist: Biologist Ludwig von Bertalanffy

What are the major assumptions of the theory?

The different assumptions of the theory include self-organization, interdependence, effect, reflexivity, and observation. These assumptions play a significant role in helping in the establishment of the differences between cybernetics and system theory from other sciences.

What are the theory’s key concepts?

The theory is shaped by three key concepts which must be comprehended in the procedure of the theory analysis. The first concept is a system, an entity organized and composed of interrelated and interdependent parts. Homeostasis is the second element, and it is a system that tends to portray resilience towards the external jurisdiction and strives to sustain its essential characteristics. Lastly are boundaries, obstructions that describe a system from other systems present in the environment.

What is the theory’s focus or unit of analysis?

The system theory relies on complexity and interdependence. From the description, the system comprises interdependent groups of events that mingle regularly and establish the plan.

What is the theory’s overall explanation for the cause of problems?

In problem description, system theory focuses widely on the entire picture and does not significant on a single element of the scenario. It emphasizes the whole concept and has a broad appreciation of the relationships on different levels, thus acquiring an interdisciplinary approach. Therefore, according to this theory, the emergence of a problem only occurs after reviewing the situation in context.

Application to a Case Study

Directions: For each section, respond to the following prompts. Where relevant, provide citations to support your claims.

In

1

to 2 sentences, how does the theory define the client’s presenting problem?

My chosen case study is of Ella Schultz, a sixteen-year-old white female of German descent. Ella will be enrolled in a teenage-counseling program, and we fully understand that she has a severe problem with running away from home. According to her case, she has been arrested two times on accounts of two occasions for shoplifting and once for loitering in the last seven months

In 1 to 2 sentences, how does the theory explain the cause of the client’s presenting problem?

. Ella’s challenges started when her father started physically abusing her, and her mother seemed disinterested in helping her.

In 1 to 2 sentences, how does the theory explain the social worker’s role for this client?

The role that the social worker will be playing in Ella’s life will revolve around investigating and determining the history of Ella starting from her childhood, family, education, health, and other relevant backgrounds that will assist in determining the main issue and assist her in developing a resolution to the problem. The social worker will also provide advice and proceed to enroll Ella in a system that will enable her to get appropriate education, sound interactions, and medical treatment.

In 1 to 2 sentences, what does the theory say about how this client will improve or change occur?

For Ella, the theory proposes that the entire problem arises from the chain parts of causes. To be able to provide her full support, these sections must be resolved interdependently because, upon approval, her parents will be brought in for a complete history of events in Ella’s life. She will be reunited with her mother and offered the opportunity to acquire appropriate medical assistance, education, and counseling. This will allow her to absorb change gradually and focus more on living a successful life.

Using the theory, list two to three (2–3) assessment questions to ask this client to explore the client’s goals and how they will get there.

The assessment questions include what you wish to do after being discharged from the facility. Do you want to continue with your education?

According to the theory, identify two to three (2–3) specific practice intervention strategies for the client relative to the presenting problem. For each, explain in 1 sentence how it will help meet the client’s goals.

The practice intervention efforts are a medical treatment that will ensure that she undergoes a thorough medical checkup and enroll back in school to help her develop a sense of focus.

Based on the theory, list two to three (2–3) outcomes when analyzing whether an intervention is effective.

The success of the intervention will be determined if Ella can quit shoplifting and go back home. It will also be indicated if she will go back to school.

What is one strength and one limitation in using this theory for this client?

The payback of employing this technique is that Ella will be aware of her situation. On the contrary, the weakness will be that controlling her to undergo these changes might be an issue.

1

© Walden University, LLC

© Walden University, LLC 1

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

© Walden University, LLC 2

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,

© Walden University, LLC 3

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.

© Walden University, LLC 4

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)

© Walden University, LLC 5

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

© Walden University, LLC 6

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

© Walden University, LLC 7

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.

© Walden University, LLC 8

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)

© Walden University, LLC 9

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.

© Walden University, LLC 10

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.

© Walden University, LLC 11

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)

© Walden University, LLC 12

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
shopping for Magda, clean her home, pay her bills, and keep track of Magda’s
medications. Since Helen thought she was unable to continue caretaking for both
Magda and her husband and kids, she wanted the helper to come in more often, but
John said they could not afford it. The money they now pay to the helper is coming out
of the couple’s vacation savings. Caring for Magda makes Helen think she is failing as a
wife and mother because she no longer has time to spend with her husband and
children.

© Walden University, LLC 13

Helen spoke to her husband, John (the family decision maker), and they agreed to have
Alec (their son) move in with Magda (his grandmother) to help relieve Helen’s burden
and stress. John decided to pay Alec the money typically given to Magda’s helper. This
has not decreased the burden on Helen, since she had to be at the apartment at least
once daily to intervene with emergencies that Alec is unable to manage independently.
Helen’s anxiety has increased, since she noted some of Magda’s medications were
missing, the cash box was empty, Magda’s checkbook had missing checks, and jewelry
from Greece, which had been in the family for generations, was also gone.

Helen comes from a close-knit Greek Orthodox family, where women are responsible
for maintaining the family system and making life easier for their husbands and children.
She was raised in the community where she currently resides. Both her parents were
born in Greece and came to the United States after their marriage to start a family and
give them a better life. Helen has a younger brother and a younger sister. She was
responsible for raising her siblings, since both her parents worked in a fishery they
owned. Helen feared her parents’ disappointment if she did not help raise her siblings.
Helen was very attached to her parents and still mourns their loss. She idolized her
mother and empathized with the struggles her mother endured raising her own family.
Helen reports having that same fear of disappointment with her husband and children.

Employment History
Helen has worked part time at a hospital in the billing department since graduating from
high school. John Petrakis owns a Greek souvenir shop in town and earns the larger
portion of the family income. Alec is currently unemployed, which Helen attributes to the
poor economy. Dmitra works as a sales consultant for a major department store in the
mall. Althima is an honors student at a local college and earns spending money as a
hostess in a family friend’s restaurant. During town events, Dmitra and Althima help in
the souvenir shop when they can.

Social History
The Petrakis family live in a community centered on the activities of the Greek Orthodox
Church. Helen has used her faith to help her through the more difficult challenges of not
believing she is performing her “job” as a wife and mother. Helen reports that her
children are religious but do not regularly go to church because they are very busy.
Helen has stopped going shopping and out to eat with friends because she can no
longer find the time since she became a caretaker for Magda.

Mental Health History
Helen consistently appears well groomed. She speaks clearly and in moderate tones
and seems to have linear thought progression—her memory seems intact. She claims
no history of drug or alcohol abuse, and she does not identify a history of trauma. More
recently, Helen is overwhelmed by thinking she is inadequate. She stopped socializing
and finds no activity enjoyable. In some situations in her life, she is feeling powerless.

© Walden University, LLC 14

Educational History
Helen and John both have high school diplomas. Helen is proud of her children knowing
she was the one responsible in helping them with their homework. Alec graduated high
school and chose not to attend college. Dmitra attempted college but decided that was
not the direction she wanted. Althima is an honors student at a local college.

Medical History
Helen has chronic back pain from an old injury, which she manages with
acetaminophen as needed. Helen reports having periods of tightness in her chest and a
feeling that her heart was racing along with trouble breathing and thinking that she
might pass out. One time, John brought her to the emergency room. The hospital ran
tests but found no conclusive organic reason to explain Helen’s symptoms. She
continues to experience shortness of breath, usually in the morning when she is getting
ready to begin her day. She says she has trouble staying asleep, waking two to four
times each night, and she feels tired during the day. Working is hard because she is
more forgetful than she has ever been. Helen says that she feels like her body is one
big tired knot.

Legal History
The only member of the Petrakis family that has legal involvement is Alec. He was
arrested about 2 years ago for possession of marijuana. He was required to attend an
inpatient rehabilitation program (which he completed) and was sentenced to 2 years’
probation. Helen was devastated, believing John would be disappointed in her for not
raising Alec properly.

Alcohol and Drug Use History
Helen has no history of drug use and only drinks at community celebrations. Alec has
struggled with drugs and alcohol since he was a teen. Helen wants to believe Alec is
maintaining his sobriety and gives him the benefit of the doubt. Alec is currently on 2
years’ probation for possession and has recently completed an inpatient rehabilitation
program. Helen feels responsible for his addiction and wonders what she did wrong as
a mother.

Strengths
Helen has a high school diploma and has been successful at raising her family. She has
developed a social support system, not only in the community but also within her faith at
the Greek Orthodox Church. Helen is committed to her family system and their success.
Helen does have the ability to multitask, taking care of her immediate family, as well as
fulfilling her obligation to her mother-in-law. Even under the current stressful
circumstances, Helen is assuming and carrying out her responsibilities.

Father: John Petrakis (60 years old)
Mother: Helen Petrakis (52 years old)
Son: Alec Petrakis (27 years old)
Daughter 1: Dmitra Petrakis (23 years old)
Daughter 2: Althima Petrakis (18 years old)

© Walden University, LLC 15

John’s Mother: Magda Petrakis (81 years old)

• TOC

Ella Schultz

Paula Cortez

Sam Franklin

Helen Petrakis

Analysis of Theory Worksheet

Use this worksheet to help you apply a theory as a lens to the case study for your assignments. Fill in the column on the right with all applicable information, and then consider it a reference for how to apply the theory. You must submit this worksheet, where indicated, in applicable assignments. Then you will compile the worksheet for your Theories Study Guide (that you can use for the licensure exam) at the end of the course.

Name of theory

Author or founder

Historical origin of theory

Basic assumptions

Underlying assumptions

Key concepts

Foci/unit of analysis

Philosophical or conceptual framework

Strengths of theory

Limitations of theory

Common criticisms

When and with whom it would be appropriate to use the theory/model

Consistency of theory/model with social work principles

Identification of goodness of fit with ethical principles

Ways in which theory/model informs research methods

Implications for social work practice

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