There is a short article to read and 5 questions to answer
Anne is a case manager with a community agency. One of the most effective ways to describe her work as a case manager is to read about one of her recent cases illustrating what she does.
Elizabeth and Gordon Bethke were referred to Anne by their daughter’s physician after they indicated they were struggling with their daughter’s anger management and attitude.
At our first meeting, I learned that the Bethkes had been married for twenty-five years and had three daughters. Their oldest, Courtney, 23, lives in France doing graduate work for her mechanical engineering master’s degree. Christina, 20, is a junior in college. After this year, the Bethke’s were preparing to become empty nesters and were struggling with their youngest daughter, Whitney, eighteen and a senior in high school.
Courtney and Christina are both in college and are very independent. Whitney, on the other hand, has struggled with dependency—being dependent not only on her parents but also on her boyfriend and friends. She has relied very much on her looks and style to get what she wanted. Having been fairly strict parents while raising the first two, Gordon and Elizabeth were having a hard time keeping track of Whitney.
As the problems continued to unravel, so did the story of a very troubled marriage. I suggested meeting with Gordon and Elizabeth separately to attempt to get a more complete picture of the situation. They were both agreeable.
Meeting with Gordon revealed a man who did not like to admit to any problems with his marriage; truthfully, they appeared to have been struggling quietly for years. Gordon was a man who was aggressive through his silence. He tortured his family, not with alcohol or beatings, but with the silent treatment. He controlled his wife with manipulative behavior in the bedroom. After talking with him, it was evident that Gordon was an angry man, upset with the hurt that his wife had caused him. He would admit his anger or frustration to Elizabeth. When she would inquire why, however, he would refuse to talk to her. In this way, he controlled her emotions and behavior.
Meeting with Elizabeth uncovered a woman who was dying to talk to someone about her struggles with Gordon. I realized how truly unhappy Elizabeth was with her marriage. She felt trapped. She felt the only time she could be herself was when she was not with Gordon. She admitted that, a few years ago, she had met a man who seemed to understand her. This made her realize that, in all of these years with Gordon, she had never been the person she thought she was.
The man Elizabeth felt a connection with was a close family friend. It hurt Gordon very much when he became aware of the strong feelings between Elizabeth and the friend. The couple agreed not to speak or socialize with this friend anymore and to try to work things out between them. Elizabeth became submissive and willing to do whatever it took to make their life together appear loving from the outside. Although she was dependent on Gordon, she continued to be drawn emotionally to the friend and began to speak and meet with him behind Gordon’s back.
The family initially came to the agency because of Whitney. Once they were accepted for services, Whitney was the easiest person in the family to work with. Before the meetings, Whitney was aggressive toward her parents and sisters, hung with “the wrong crowd,” drank and smoked, and skipped class. Her grades had dropped from a strong B+ to all Cs and Ds. Every time something would not go her way, she would lose control and scream at her parents. The next day she would act as though nothing had happened.
Whitney came voluntarily and, after some rapport was established, she talked openly about what her life was like and how she wanted things to be. She hated soccer but felt intense family pressure to continue playing. Gordon was a former professional hockey player, and both sisters had played or were playing collegiate soccer. We explored a number of options for Whitney. She finally decided to quit playing soccer and to try out for cheerleading. This was an uphill battle for her because cheerleading was unknown to the Bethke clan. Whitney persisted, made the cheerleading squad, and finally felt some success of her own. In her high school, all athletes signed a “blue sheet” stating they wouldn’t smoke, drink, take drugs, or skip class. A certain grade point average was mandatory. Although her old friends didn’t want anything to do with her now, she began hanging out with her cheerleading teammates. Her grades improved, and, although her temper is still hot, she had learned to apologize. I believe that if Whitney continues to receive positive reinforcement and affirmation for who she is and for her abilities, she will continue to grow and develop into a mature young woman. We will continue to work on anger management once every two weeks.
Unfortunately, for Gordon and Elizabeth, life won’t be that easy. I referred Gordon to the center’s psychologist for an evaluation. He was diagnosed as passive-aggressive, and therapy was recommended. I have arranged for him to see a counselor who works well with males. I believe he will also benefit from participation in a group at our center for people who want to change behaviors. His negativism and inability to accept responsibility for his behavior are particularly troublesome in his marriage. One of Gordon’s assignments has been to read about his diagnosis and, although he isn’t completely in agreement with his diagnosis, there is some improvement in his ability to talk about his feelings.
Elizabeth has agreed not to see her friend until she has worked things out with Gordon. Her physician suspected she was depressed and a psychological evaluation by a psychologist at the center supported a diagnosis of clinical depression. She refuses to take any medication for it. I will continue to meet with her once a week. We are trying to develop a plan of action for her so she has some goals that will allow her to improve her self-concept and take responsibility for her well-being.
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