Dissociative Identity Disorder Case Study for Interventions

• Elizabeth Flores

STUDY

Claireese Jones is a 16 year old African America teenager living in Harlem, New York. She is the only child of Mary Jones. Claireese has two children, one boy and one girl. Claireese daughter, Mango, is four years old and is diagnosed with Down syndrome but lives with Claireese grandmother. Her youngest son, Abdul is eight months old. Claireese is attending, Each One, Teach one, Alternative School and is currently in the eight grade. She is currently not working.

B. Setting

Harlem’s Women Center is a shelter for women who have children and were physically or mentally abuse. They work with women to reduce the physical, psychological and emotional trauma and the recurrence of domestic violence, sexual assault and incest experience by many of their clients. They work to secure their physical, emotional well being, individual freedom and economic equality. The agency offers counseling, legal services, childcare services, parenting classes, support groups and job readiness and job placement for their clients. The agency receive 97% of their revenues from government grants.

C. Reason for referral

Claireese was referred because she was recently homeless and was placed in a halfway house. She was referred by Ms. Rain, her teacher, who reported that she found Claireese in school, sleeping with her 3 day old son because her mother tried to kill her when she return home from the hospital. Claireese needs various services so she can eventually get her own place and support her children independently. She will need daycare services, so she can still continue to attend school, and earn her high school diploma. The social worker from the Welfare department reported that Claireese needs counseling to address experiences that were traumatic to her life. She will need extensive counseling. She needs to learn how to manage and care for her well being since she is already overweight and possible future health issues she will encounter in the future because of her diagnosis of HIV. Claireese has also experience episodes of blanking out and daydreaming.

D. Description and Functioning of Client

Claireese is considered overweight for her age. Her clothes are clean and she is always wearing cosmetic jewelry to match her outfits. She has her hair done and wears it differently. She can be verbal and nonverbal when talking to her at times. Client seems to be daydreaming when we discussed certain events in her life. She uses a lot of inappropriate language to describe how she feels.

E. Physical and economic environment

Claireese lives in a halfway house with her two children in Harlem, New York located in Manhattan. She receives a stipend while she attends school. She is also on welfare where she receives cash assistance and food stamps. She attends, Each One Teach One, Alternative school, Monday through Friday, in the day time.

F. Current Social Functioning (as reported by parents/caregivers or child/teen or obtained from written reports)

Claireese is estranged from her mother due to her abusive behavior towards her and her children. She has not seen her father since he last raped her, which is before she was pregnant. She knows that her grandmother would like to help her but is aware that she is also afraid of Mary. Client’s daughter, Mango, lived with great grandmother so client can attend school. Mary blames Claireese for being raped by her father and even accuses Claireese of stealing Mary’s boyfriend. Mary told her she is fat because she eats too much. Her mother never encourage her to attend school and told her it was a waste of time. Her mother is always telling Claireese, she is too stupid to learn anything. Claireese reported she never had a boyfriend but wish that she can have one in the future even though she feels she is too ugly and fat. She had two pregnancies that occur from her being raped by her father.

Claireese is a currently attending Each one, Teach One, alternative school, pursuing her High school Diploma so she can teach her children something. The client’s teacher, Ms. Rain, motivated Claireese to want read and write by encouraging her to do her best. She was surprised by her success in her ability to read and that she was actually beginning to write. Her sense of personal competence is in development; she states that she did not think that she was very smart, but that her class work and successes are changing that opinion of herself. She is grateful for having John, Ms. Rain, her friends for their support and encouragement. She never thought that there would people who would really care for her. The client’s primary social supports are her peers and her teacher in the school.

G. Personal and family history relevant to focus of assessment

Claireese was sexually abuse since the age of three by her biological father, which produced two children. She has also been mentally and physically abuse by her mother. There is also a possibility of sexual abuse by her mother. Claireese just recently learned that she contracted the HIV disease from her father who recently died of the disease. Claireese grandmother took cared of Mongo, so Claireese can go to school and Mary can still collect welfare based on fraud. Claireese has always depended on her mother up to now, even though moms have lived off of Claireese’s welfare check.

ASSESSMENT

Psychological functioning

1. Intellectual functioning- Client was not able to read or write but express interest in Math. Since attending the alternative school, client has been able to improve her reading and writing skills.
2. Reality testing- Poor, client seems to suffer from delusions. Whenever the client is dealing with stressful experiences, she is not listening and seems to be out of tune at the moment. She explains that she daydreams and imagines that she is someone else living a different lifestyle. She is not aware what is happening to her at the time of incident. She also images that the pictures in her photo album talks to her.
3. Coherence – Unimpaired, despite the client having delusions and has an imagination she can maintain on task whenever she is not dealing with stressful events.
4. Impulse control-Good, Client tries to control her behavior by not getting herself in any more trouble than she has to. She has gotten herself transfer from her old school not only because of her being pregnant again because she threaten the principal.
5. Judgment- Good; client have been able to make good judgments. She continues to go to school, so she can teach her children and earn her diploma.
6. Memory/recall- Poor: she can recall some but not all information that pertains to her traumatic experiences and whenever she addresses those experiences she goes into her fantasies.
7. Coping style- Poor; Client has never been able to deal with her traumatic experiences in a healthy way, even though she uses her imagination to forget what happened.
8. Defense mechanisms: Poor: Client daydreams and uses her imagination as a way to cope with stressful experiences.
9. Insight- Poor; Client has no idea how her traumatic experiences contributes to her mental issues.
10. Self-Perception-Fair; client has the confidence that she needs to complete school and even with her illness she is confident she can still provide for her children.

Emotional Functioning

1. Ability to express feelings- Good, she is able to express how she feels.
2. Rage of emotions-unimpaired: Client can express herself if she is more open to talking about how she feels. Once she sees that people care for her she can discuss how she is feeling.
3. Appropriate of affects-Impaired; Client seems to avoid talking about specific events, she will change the topic so the focus is not on her. This may be the client way of denying what happen.
4. Predominant mood- Poor; Client is depress and sad.

Social/behavior functioning

1. Ability to form relationships – Unimpaired; client demonstrates an ability to form relationships as evidenced by her ability to develop friendships with peers in her school. She also developed a friendship with one of the male nurses at the hospital.

2. Social skills/social competence – Poor; client demonstrates a lack of social skills.

3. Overall role performance – Improving; client’s role as mother is improving, she is now taking care of both her children and continues to attend school. Her role as a student is great; she continues to improve her grade level reading. She went from reading at a second grade level to an eighth grade level.

4. Other functional behaviors, if appropriate – Good; client has developed relationships through her school. Client has no other friends other than school.

D. Environmental issues and constraints affecting the situation.

1. Family – Poor; family is not supportive; mother is emotionally unstable and abusive towards Claireese. Her grandmother is too afraid of Mary, so she would not be able to assist Claireese.

2. Agency – Great; this agency is able to provide significant support in providing necessary services that Claireese needs. She has the availability of a daycare, so she can continue her education. She will receive housing assistance, so she can transition from the halfway house into her own place.

3. Community – Moderate; client’s neighborhood provides affordable housing and it is near public transportation and the school that she attends.

5. Physical Constraints, if appropriate – Poor; client recently discovered she is HIV positive and future health concerns associated with the illness will become a problem for her.

6. Economic Constraints, if appropriate – Fair; client has limited income from TANF and food stamps and she is currently living in a half way house.

E. Motivation and commitment to services

Claireese is very motivated in continuing her education. She wants to get her High School diploma. She wants to be able to learn how to read and write. She feels that if she continues to learns how to read and write, she can teach her children. Despite the fact that she has HIV, she clearly feels she still can be successful and do for her children, what her mother didn’t do for her. She wants to prove to her mother that she is wrong. Her motivation is influence by her wanting a better future for her children.

F. workers understanding of clients presenting situation/problem (person-in-environment)

Client seems to be experiencing symptoms of Dissociative Identity Disorder. These symptoms include flashback, amnesia and emotional numbness. When dealing with stress, client escapes reality by daydreaming. She may have developed this disorder due to her traumatic experiences, starting with her being raped by her father. Whenever the client experience stressful events, she has fantasies about her being famous and being someone else, she even sees herself as a white blond girl. Client has no control over her daydreaming. She seems to not remember how she was first raped.

Psychoanalytic theory help explains that client’s problems can be associated with painful childhood experiences that can sometimes be repressed. These repressed memories can shape the clients feelings, thoughts and behavior. These repress memories can be seen as defense mechanism (Robbins, Chatterjee, & Canda, 2012). The client uses her fantasies as a way of ignoring what is happening at the present time, which is not healthy as the client condition can worsen and create maladaptive behaviors. Client repressing these traumatic experiences may explain how the client coped with these experiences.

It is important to look at Erickson’s stage theory because it recognizes the importance of a person’s social location and the interaction between other individuals rather than just the family system. (Berzoff et al., 2011). Since, the client family system is not the strongest support system, the school staff and students are important people that provides positive feedback to the client. This will help the client learn to establish positive future relationships.

Strengths Perspective is an approach to understanding the client in terms of her strengths, abilities, motivations, knowledge and available resources. (Guo & Tsui, 2010) These qualities help the client the ability to solve their problems. This also can give you an idea how the client, who experienced many events in her life, overcame these obstacles and continues to attend school. (Robbins et al., 2012) They also talk about the courage an individual may have. She had the courage to confront her mother and finally leave the house in order to protect her children.

Strengths Perspective focuses on the social environment as having many resources that can help individuals overcome obstacles. People have the ability to learn, grow and change. Client has the abilities to continue to grow so she can provide for her children.

References

Berzoff, J., Flanagan, L. M., & Hertz, P. (2011). Inside Out And Outside In (3rd ed.). Maryland: Rowman & Littlefield.

Robbins, S., Chatterjee, P., & Canda, E. (2012). Contemporary Human Behavior Theory (3rd ed.). Saddle River, NJ: Pearson Education.

Guo, W., & Tsui, M. (2010). From resilience to resistance: A reconstruction of the strengths perspective in social work practice. International Social Work, 53(2) , 233-245. http://dx.doi.org/10.1177/0020872809355391