Social Work - Biopsychosocial Case Term Paper

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She did not have the benefit of a bedroom door for the last two years of high school.

Without the bedroom door, the client changed her clothes in the bathroom and was often unable to sleep at night because of her father's snoring. The first time her mother confronted her for being wide awake (and reading) in her room in the middle of the night, the client admitted that her father's snoring kept her awake. A few minutes later, her father entered her room and whipped her with the belt for "being disrespectful."

After discovering that alcohol allowed her to fall asleep and sleep through the night, she began drinking vodka at bedtime, which she chose because it was odorless and easy to hide in alternative containers in her room and among the cleaning supplies in the bathroom cabinet.

The client has always recalled the details of her childhood physical and emotional abuse, but until recently, never remembered or even suspected ever having been sexually abused by her father. On the day that her oldest daughter asked for assistance in connection with her first menses, the client entered the bathroom and began to render assistance when she experienced a vivid spontaneous recollection of what she now believes was the last time her father abused her sexually. On that occasion, her father had entered her bed after she was asleep and attempted to penetrate her vaginally with his fingers. She recalls pretending to be asleep and that when her father encountered her tampon, he withdrew his hand and left her bed.

In the first day after that recollection, the client began spontaneously recalling the entire history of her father's sexual abuse which apparently began when she was approximately 10, continuing until the day that her father discovered that she had begun menstruating, after which he simply stopped. During that time, she had learned to feign sleep whenever her father entered her bed.

During her freshman year of college, she was befriended by two upper-class students two years her senior within the first week of school. One of them offered to assist her carrying boxes and luggage from her first dormitory assignment when a single room opened up to her shortly after arriving on campus. Once alone in the room he initiated a sexual advance which she did not desire, but which she felt powerless to resist, freezing" in one of the classic responses of chronic sexual abuse victims (Graziano

1992) and in the same manner that she now recalls doing whenever subjected to her father's sexual abuse.

While she did not reciprocate the student's advances, she did not react when he continued and the encounter culminated with intercourse. It was her first sexual experience. The scenario repeated itself throughout the first month of college and the client recalls "freezing" the same way every time in addition to focusing on a particular light bulb hanging from the ceiling whenever her classmate initiated subsequent encounters. She began avoiding the student but the scenario continued to repeat itself when he began showing up to her room unannounced. On one occasion, he was accompanied by one of the others from the group that had befriended her earlier and both students began participating in the encounters while she continued to freeze for the duration, mainly detaching from her bodily perceptions and staring at the light bulb.

When no complaints or other repercussions resulted from these encounters, all four members of the group began showing up at her door late at night, in various combinations, but usually in pairs. This situation persisted for two full years until all four graduated. Despite the fact that the sexual aspect of these encounters were not forced, they were not consensual either, although she recalls experiencing tremendous shame throughout for allowing four different men to have sexual relations with her.

Initially, the client was relieved when none of the four men were on campus when she returned for her junior year, she recalls also feeling abandoned and she eventually began engaging in sexual affairs with relative strangers that she initiated.

Typically, the men she selected for these affairs had demonstrated rudeness and obvious potential for abusive conduct. Just as typically, they sought to continue more of a relationship, but she resisted those efforts, preferring to limit her relationships strictly to their sexual component. The most common course of those relationships was for her to begin freezing instead of responding to them sexually, in response to which some of the men she dated became frustrated and abandoned her.

Several times, her freezing resulted in intercourse in the same manner as it had with the upperclassmen, but the relationship ended after one or two such consummations.

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On two occasions, her sexual partners managed to ingratiate themselves to her beyond their physical relationship, although this required considerable effort on their part. Both of those relationships became verbally and physically abusive and she recalls purposely antagonizing both partners by knowingly creating situations that appeared, in one case, to demonstrate infidelity on her part, and in the other case, to suggest her romantic interest in a mutual acquaintance in whom she actually had no interest at all.

Even at the time (i.e. long before any recollection of childhood sexual abuse by her father) she recognized that she was recreating elements of her relationship with her parents and their perpetual accusations (and punishment for) supposed violations of family rules and other transgressions that were, in fact, false. This too, reflects a common pattern of indirect recreation of unresolved past abuse (Marton 1988).

Prior to the episode with her daughter that triggered the client's first recollection of her childhood sexual abuse, she had no idea as to the origin of her freezing response to undesired sexual advances. Afterwards, she began resisting her former husband's attempts at initiating sexual encounters, which provoked him to abuse her physically, precipitating the calls to law enforcement authorities by her neighbors. At approximately the same time, her own newly-recalled history of abuse and its connection to her onset of menses prompted her to question her oldest daughter about her relationship with her father, whereupon the child disclosed that her father had indeed molested her regularly since the age of eight.

Clinical Assessment and Treatment Goals:

The client has been deeply affected by many different aspects of her psychological history. In terms of issues that relate directly to her referral to social services, she is drawn primarily to men who naturally exhibit potential for abusive conduct to which she was accustomed to when she lived in her parents' home. As is commonly observed among perpetual victims (Goldstein 1995), she is unconsciously repeating patterns of behavior that have a high likelihood of perpetuating the same abuse.

The fact that her memories of early sexual abuse by her father were previously completely repressed, probably contributed very significantly to her tendency to recreate similar situations as an adult. Generally, the less conscious a subject's awareness of specific issues in the past, the greater the unconscious obsession with repeating it, which seems especially true where the abuser was a perpetually critical parent figure (Meyer

1993).

This client was (understandably) emotionally incapacitated by the sudden realization of having been sexually abused by her father for two years. The memories were likely triggered by the relevance in, her own psychological past, of the onset of menses. Initially, she responded in the same pattern that had helped her cope with stress previously, (Reding & Wijnberg 2001). Because of her education and her ability to understand the causal relationship between her past experiences and her choices, she has demonstrated significant progress in conscious behavioral changes. Her prognosis for benefiting further from therapeutic analysis and continued treatment are, therefore, very high.

Treatment goals for this client include addressing past experiences and relating them to future issues. To a great degree, the client's self-esteem has already improved, specifically with respect to the guilt for which she had previously felt responsible for allowing" four men to have regular sexual access to her in college. In treatment, the client has referred to the therapeutic benefit of understanding the mechanism by which she was simply drawn to repeat unconscious response patterns in similar situations. To ensure against any possible future recurrence, she has enrolled in a women's self-defense program. She purposely chose a program that emphasizes retraining victims to develop assertiveness in potential scenarios for victimization. Specifically, it features exercises designed to assist former victims recognize dangerous situations, respond appropriately, and resist any preconditioned responses consistent with being re-victimized in the future.

The client reports that her conscious awareness of her natural tendency to pick partners with many behavioral traits in common with a critical, abusive father has had the beneficial result of enabling her to recognize and purposely avoid such individuals instead of responding to her desire for….....

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