Abstract
This paper focuses on a potential client for a Licensed Clinical Social Worker (LCSW). The client to be discussed is Brett Mitchell, a twenty-five-year-old African American male who is unemployed, and the child of recovering drug-dependent parents. Studies show that Adult Children of Addicts (ACoAs) present with a range of symptoms that run the gamut of psychiatric and stress-related disorders, from substance-abuse disorders and other addictions to depression, anxiety, personality disorders, and maladaptive coping mechanisms. In the case of the client to be discussed in this paper, he is seeking counseling for identity confusion, depression and arrested psychosocial development. After a discussion of the problems affecting this client, the paper suggests two evidence based treatment options: 1) Cognitive Behavioral Therapy (CBT); and 2) the introduction of exercise as an adjunct to CBT. The paper concludes with recommendations for addressing the problems affecting the client, as well final thoughts on the client’s prognosis.
Introduction
The client to be discussed is Brett Mitchell. He is twenty-five years old, unemployed, and currently living in Dallas, Texas. Brett’s parents divorced when he was 12, and both are recovering addicts. He grew up in Texas, but moved to San Diego, California during high school to live with his paternal grandparents, thriving in a stable home environment that allowed him to focus on academics rather than the dysfunctional home life he experienced throughout his early childhood and formative years. Ten years after moving away from his dysfunctional home for what he hoped would be a fresh start, Brett finds himself back where it all started: unsure of his future, low-esteem, and struggling with the process of self-realization.
Since relocating to Texas from Portland, Oregon a little over a year ago, Brett has had a hard time maintaining and keeping steady work. At present, he has been unemployed for six months. What’s more, despite having earned a Bachelor of Arts degree from Stanford University, he has primarily worked menial, minimum wage jobs. Understandably, against the backdrop of his chronic underemployment, Brett describes experiencing a worsening state of depression and increased self-isolation from his family and small network of friends. After contemplating suicide, Brett finally summoned the courage to seek help. He was subsequently prescribed anti-depressant medication and agreed to talk-therapy with a Licensed Clinical Social Worker. Two-weeks later, Brett and I had our first session to discuss in greater detail the circumstances that motivated him to seek help and also to lay out some preliminary goals for treatment. Despite some initial ambivalence about the merits of talk therapy, Brett eventually opened up to me once he found resonance in our shared humble beginnings in impoverished neighborhoods and dysfunctional family units. In additional to bi-weekly sessions with me, Brett has been in regular attendance at a local support group for families afflicted by alcohol and addiction (Al-Anon).
Brett’s describes the overwhelming feeling that fits the classic “man with no country” archetype. On the one hand, his access to higher education sets him apart from most in his extended family and the circle of friends he knew as a fatherless African-American male in the inner-city. He feels conflicted about the extent to which his educational attainment and ability to experience diverse opportunities away from his hometown have aliened him from his family and childhood friends, many of whom never having made it out of Texas, much less being exposed to others with divergent worldviews and life experiences. On the other hand, he reports his impoverished and dysfunctional family roots as being notable points of distinction with his upper-middle class peers at the elite Stanford University. Consequently, Brett’s status as a minority within a minority made it difficult for him to form healthy relationships once he managed to beat the odds by not only earning admission to one of the nation’s most selective institutions of higher learning, but also being among the first in his family to graduate from college. It is no wonder, then, that Brett now finds himself in what he aptly described as “a constant state of paralysis by analysis.”
Overall, Brett certainly seems to exhibit all the hallmarks of what developmental psychologists define as the Adult Child of an Addict (ACoA). Woititz (1983), and Whitfield (1987) were among the first to label the identifying features of this syndrome- a range of symptoms that run the gamut of psychiatric and stress-related disorders, from substance-abuse disorders and other addictions to depression, anxiety, personality disorders, and maladaptive coping mechanisms. According to Friel (1988), these symptoms are formed “as a way of protecting us from a pain that we as children had no power to remove” (23-4).
Of course, not all adult children are created equal. Even so, certain characteristics seem to hold true for most adult children – whether there was addiction in the family or not. For instance, adult children like Brett absent appropriate intervention, experience lower levels of self-realization, with an increased risk of identity confusion (Maynard, 1999); are more likely to suffer from arrested psychosocial development (Windle, 1997); and are even more likely to suffer from emotional distress arising from low self-esteem (Cutter, 1987).
Evidence-Based Treatment Options
Recovering from Adult Child issues begins with a simple, but often overlooked guiding principle. Friel (1988) makes the case that the adult child must first come to terms with the inarguable truth that “The core inside of us has been damaged. We have called this core inside of us our Little Child. What needs to heal are the guilt, shame, and fear of abandonment experienced in our Little Child. Ultimately, our healing must take place from the inside out” (185).
Research suggests that Cognitive Based Therapy (CBT) treatment would help Brett in many profound ways. Consistent with the developmental psychoanalytic view that the Adult Child is burdened with a dysfunctional inner core, CBT addresses this dysfunction by allowing the patient and therapist to target the maladaptive inner-thinking that distorts the Adult Child’s affect and behavior (Hayes, Hildebrandt, Levin & Villatte, 2011). At the core of mainstream CBT is the focus on lowering emotional stress by labeling cognitive distortions -defined as the erroneous and maladaptive thought processes – and replacing them more adaptive ones. As an adjunct to CBT, research has also shown a strong correlation between increased exercise and improved mental health (Ruben, 2012).
Recommendations
Brett should continue to attend our bi-weekly sessions. I would also suggest that he continue in his quest to find support and camaraderie with individuals with shared experiences. Currently, he is attending Al-Anon meetings, but I would also recommend that he also find online support groups as well. Additionally, although he is in good physical health, he doesn’t really exercise much, and mainly confines himself to his room. I’m going to recommend that he join a local gym or figure out a way to incorporate some form of physical activity into his weekly routine. Aside from being good for his overall mental health, being more active will allow Brett to get out of the house more and gradually become more social. Although introverted, he has a very charming personality once you get to know him, so I don’t think he’ll have any problem making new connections once he puts himself out there. Overall, Brett’s prognosis is good and I look forward to charting his progress.
Social History
Identifying Information:
DOB: 24 May, 1990
Reason for Report: Brett was referred for outpatient treatment for Major Depressive Disorder and suicidal ideation.
Reason for Social Work Involvement: To help Brett begin to deal with emotional stress of being an adult child of drug dependent parents.
Source of Data: Brett himself.
Family Background and Situation: Both of Brett’s parents are recovering addicts. He has three siblings: an older brother and two younger sisters.
Extended Family: Paternal grandparents, aunts, uncles and cousins residing in California, Texas, and Michigan.
Education History: Bachelor of Arts (Stanford University c/o 2012).
Work History: Unemployed. Cashier at Subway (2 years). Freelance Web Designer (4 years).
Legal History: none
Recreation: none
Physical Health and Overall Functioning: Brett is in good health, but not physically active.
Mental Health Issues: Struggling with depression, low self-esteem, and arrested psychosocial development
Interpersonal and Social Relationships: small group of friends, but lately he hasn’t kept in regular contact with them.
Religion and Spirituality: Brett is agnostic.
Economic/Housing/Transportation: Brett is currently unemployed and receiving unemployment insurance. He is currently renting room in boarding house that has six other occupants. The house is in a working class neighborhood that is located five miles from downtown. He doesn’t have access to a car, but lives very close to public transportation.
Community Resources and Uses: Brett immediate family is suspicious of therapy, but he has a supportive group of extended family and mentor who’ve been involved in his life since college. He also attends a monthly support group for the families of alcoholics and addiction.
Overall Impression: Although initially quiet and reserved, Brett has gradually opened up and genuinely seems to enjoy our sessions. The emotional distress he feels as result of his Adult Child issues still looms large, but he is nonetheless happy that he is on a road to recovery.
References
Hayes, S., Hildebrandt, M., Levin, M., & Villatte, M. (2011). Open, aware and active:
contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual Review of Clinical Psychology, 7(1), 142-69.
Herzog, Catherine (2007). Social work with children of alcohol and drug-dependent parents.
Social Work Today, 7(4), 30.
Ruben, Joelle. (2012). Using exercise to combat depression. Social Work Today, 12(1), 22.
