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Bio-Psycho-Social
Crystal McMillon
Wayne State University
Bio-Psycho-Social
Referral Statement
Dominique Smith (pseudonym) comes from an impoverished area with limited
resources. She is currently facing a myriad of challenges due to the sexual assault she
experienced during her adolescence: high levels of anxiety (frequent reoccurring thoughts
and visions of her sexual assault), which have lead to self-destructing behavior with the
abuse of alcohol (drinking an average of 4 days a week), complaints of depression
(insomnia, sleeping an average of 4-5hrs a night and feelings of sadness and emptiness),
and relationship issues (issues with trust and commitment). She is now enrolled in
National Counsel on Alcoholism and Drug Dependency (NCADD) treatment program to
assist her in the healing process along with her issues of substance abuse, upon her
mothers request. Client has been enrolled in this treatment program since 8/5/2015. She
does believe that a more serious, committed program is needed in order to lead her down
the right path of healing and recovery, which is why she seek services here at this
SASHA Center on 10/12/2015. Per client I would like to feel normal for once in my
life, by addressing my trauma with outpatient services that you offer.
Identifying Information
The clients name is Dominique Smith. Her date of birth is 09/06/1994 she was
born in Detroit, Michigan. She is an African-American, who is currently 21 years of age.
Client is Baptist. She received her high school diploma from Belleville High School in
2011. She is currently employed at a local strip club as a waitress. She is single, and was
living with her mother at XXXXX Riverview St, Detroit, MI until she was put out due to
her issues with substance abuse. She currently has no permanent address, and is living
with various friends. Her mother stated that she wouldnt allow her to return home until
she seeks help.
Problem Identification and History
A. Presenting Problem
Dominique comes from an impoverished area with limited resources. She is
currently facing a myriad of challenges due to the sexual assault she experienced at the
age of 18. She is currently homeless, due to her issues at home, which stem from her
challenges with substance abuse. Dominique currently has been living with different
friends. She is currently enrolled in NCADD treatment program for her substance abuse
issues. Client states that she often has repeated thoughts of the assault and nightmares.
Client also stated that she likes to drink to help her cope. She states that when she drinks
it numbs the pain and suppresses her memory. Client states that her drinking has become
a problem in her relationship with her mother, which is why she is seeking help. She feels
as though she is depressed, but has never been diagnosed or received any prior help
regarding her issues. These issues have been ongoing for three years since the time of her
sexual assault.
B. History of Problem
The client reported her substance abuse as I only drinking socially, my mother is
just worried. The patient only made one attempt to the solution, which is the outpatient
treatment therapy at NCADD. The history of her sexual abuse problem has been
occurring for three years. Client states At time I feel worthless, especially when I realize
the moments of my sexual assault, but I have never contemplated suicide.
via social media. Client indicated that she loves Instagram, Snapchat and Twitter. Client
stated Twitter is my favorite social site because it provides me with an outlet, its like my
online diary.
B) Client is verbal and able to communicate her feelings. When it comes to commitment
and trust client has issues in this department. Dominique stated that she might meet
someone and be very playful and sexually active, but then shut down sexually as the
relationship proceeds and deepens. Since a close friend sexually assaulted Dominique she
has issues with trust especially when it comes to her emotions. She indicated that the
closer she becomes to someone, no matter what the trust issue always resurfaces. She did
state that at times she has limited ability to feel sexual pleasure, specifically orgasm,
which leads to he promiscuity. She stated that her other relationships are fine, trust only
comes in to play when its dealing with someone that she is dating.
C) Client reported her father, Carlos is 45 years old and her mother, and Rhonda is 40 years
old. She reported her parents got a divorce when she was 16. She reported that she has a good
relationship with his father and reported her relationship with his mother is an emotional
rollercoaster, but knows that her behaviors are the cause. She reported that her parents are
very supportive, but believes her mother is worried that she will go down the wrong path if
she does change some of her ways. Client denied having any siblings or children. Client does
not report any family history of mental illness. Client reports that only family history of
addiction is his father who used to be an alcoholic. Client reports that her dad has been sober
for three years.
D) Client received her high school diploma. She indicated that while in high school she had a
great relationship with her peers and teachers. Her favorite subjects were English and
Science. Client also stated that she does plan to attend college, but knows at this moment she
isnt mentally prepared. Client is unsure of what she wants to major in, which is another
reason why she hasnt enrolled in college yet.
E) Client reported that she has been employed at the strip club since she was 18. She indicted
that she loves her job and the money is great. Client didnt disclose her income.
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persistent and distorted sense of blame of self or others. Finally, arousal is marked by
aggressive, reckless or self-destructive behavior, sleep disturbances, hypervigilance
or related problems.
Social workers Intervention
Survivors of sexual abuse face a myriad of long term effects throughout ones life:
negative psychological and interpersonal effects that are both long term and short term. If a
victim does not receive the proper help it only makes matters worst: by internalizing the
problem or by self-blame. By victims not receiving proper help they only increase their risk
of symptoms: depression, anxiety, posttraumatic stress disorder, substance abuse, attachment
disorders, re-victimization. Victims of sexual abuse also have future relationship problems,
due to lack of trust.
There are a numerous of different treatment methods for those who have been assaulted,
and overall it boils down to what works best for that particular individual. Cognitive Behavior
Therapy (CBT) is the current invention that is being used at SASHA. This intervention
aims to reduce the trauma symptoms among the survivors of sexual abuse . Furthermore, is
beneficial for both Dominique and future generations of this population. CBT has helped
Dominique complete goals: coping with symptoms of sexually assaulted victims and
issues with substance abuse or addiction. According to research cognitive behavior
approaches come from four theories: associative learning, the effect of the environment on
patterns of behavior, learning by imitation, and the impact of thought patterns on feelings and
behavior (Macdonald, Higgins, Ramchandani, Valentine, Bronger, Klein, ODaniel, Pickering,
Rademaker, Richardson & Taylor 2012). Results show that negative symptoms associated with
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sexual abuse: depression, post-traumatic stress, anxiety, and behavior issues are reduced
significantly after CBT.
CBT has the most effectiveness on this population with a significant decrease in their
emotional and behavioral problems. Additionally, CBT can help build interpersonal relationships
due to the interaction within therapy. Overall, Cognitive-Behavioral Therapy displays that people
can have a healthier emotional and relational strength by engaging in CBT therapy.
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Reference
Macdonald G, Higgins JPT, Ramchandani P, Valentine JC, Bronger LP, Klein
P, behavioral interventions for children who have been sexually abused. Campbell
Systematic Reviews:14 DOI: 10.4073/csr.2012.14 .
Magill, M., & Ray, L. A. (2009). Cognitive-behavioral treatment with adult alcohol and
illicit drug users: A meta-analysis of randomized controlled trials. Journal of
Studies on Alcohol and Drugs, 70(4), 516-27. Retrieved from
http://search.proquest.com.proxy.lib.wayne.edu/docview/200447901?
accountid=14925