Reference no: EM133598896

The Case of Susan

Presenting Information:

Susan is a 29-year-old white female. She is divorced with two children, a 4-year-old daughter and a 10-year-old son. She is currently in a relationship with John; they have been together for about a year. John was recently laid off from his job with a small local manufacturing company.

Susan presents to counseling with multiple concerns. She reports feeling tired and lethargic most of the time and does not sleep well. She feels decreased motivation in general and a discontent in her life, feeling like a dark cloud follows her around. She does not enjoy her life as she once did. She states, "I feel like every day is just a struggle, and I do not know where to turn." She also reports having a lot of relationship problems and challenges with her son. His behavior has become increasingly combative with a recent fight at school. In her relationship with John, she feels that he ignores her and puts everything else first. She says that he just stays with her because he has nowhere else to go, and that he does not even want to talk to her about how she is feeling in her life or about her financial concerns. She says that she loves him, but she is worried about his lack of ambition, and she is not sure she wants to stay in the relationship. She states that she cannot trust John even though she has no reason not to trust him. She also reports that her son is getting in trouble in school and that she is at a loss for what to do. He has been sent home a few times in the past three months for fighting physically and verbally, and she feels like she is a bad mother because she does not know what to do to help him.

Social History:

Susan has lived all her life in a small rural town outside a larger city. Susan was first married at age 19, when she and her boyfriend discovered she was pregnant. She had been married to Mark for six years and got divorced just after having their daughter, her second child. She states that her ex-husband was controlling and says, "He kept me on a tight leash and never gave me any slack." She reports that he had bouts of using drugs and had an affair early in their marriage. She says she tried to get over the affair but could not, stating, "I could never get the image of catching them together in our bed out of my head." She states that the decision to divorce was mutual but that he made it very difficult as he helped minimally with the kids. He is now seeing the kids twice a month and pays a small amount of child support through the state, but she says that she worries about what is going on at his house when he has the kids. She reports that her son comes back angry and defiant after staying at his dad's house for the weekend.

Mental Health and Addictions History:

Susan states that she used marijuana in her early twenties but has not used it in five years. She only drinks alcohol occasionally, having a few beers once or twice a month. She reports that she felt she was depressed while in her marriage but never sought counseling or treatment because her husband would not have let her.

Family History:

Susan is an only child. She states that her mother and father were divorced when she was 14, and she feels like she never got over that. She says, "I can just remember how they fought and yelled like I wasn't even there. I hated that time in my life, and I hated my parents." She reports that she ran away from home several times during her early teen years and that there was never enough money for her to do the things she wanted to do in school or for extracurricular activities. She states that her relationship with her mom is supportive now, but she has little contact with her dad. Susan later found out that her dad was having affairs while he was married to her mom, and Susan states that she just cannot forgive him for putting them through that. Although Susan's mother is now sober and supportive, she lives about an hour away and works full-time. Susan states, "I don't want to burden my mom with my problems or my kids."

Occupational and Educational History:

Susan went away to college but dropped out when she got pregnant and married. She got a CNA license and started back to school a year ago to work toward a nursing degree. She works full-time and lives paycheck to paycheck. She is worried about her job, saying, "I just can't get the motivation, and sometimes I can't even get out of bed to go in." She is also ambivalent about being a nurse. She states that she should be doing well since she has been a CNA, but that she has no motivation to go to school anymore, and her grades have been dropping.

Identify the most appropriate decision-making model for this case Justify why the chosen model is the most effective model to use in this case