Clinical Social Work

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Juan being in an oppressed group, developed certain criteria’s that the dominant culture associated with Puerto Ricans such as: gang member, drug addict, and unemployed.

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) Juan meets the criteria for:

Substance-Related and Addictive Disorders

Part 2: Interpersonal/Psychodynamic Assessment

Juan discussed his family of origin issue as being his father drinking excessively and his mother being his father’s enabler. Juan stated his father used the household finances to drink. Even though Juan’s father went to work daily, his after work hours were spent with his uncles drinking. Juan also stated his mother worked part-time to help subsidize the family income. Juan also stated his mother tried to cover up his father’s drinking from the children by stating “it’s not that bad, he is only relaxing”. Juan stated he was the oldest child so he felt responsible for his siblings’ well-being. Juan stated he assisted with the things his mother couldn’t accomplish such as: homework, meals making sure his siblings were in the house and they were ready to go to school. Juan stated he eventually grew tired of this situation and started to rebel. These actions were the beginning of Juan’s drug use. Juan’s experience in his home with his father being an alcoholic and his mother an enabler helped develop his Substance-Related and Addictive Disorders. Children of alcoholic are more susceptible to develop alcohol, substance abuse and emotional/behavioral disorders.

In a comprehensive review of the literature on children of alcoholics (COAs), Russell, Henderson, and Blume (1985) concluded that such children are at a particularly high risk for alcoholism and other emotional and behavioral problems, including difficult social adjustment and substance abuse. They also cited studies in which COAs were found to possess distinctive personality characteristics, including lower self-esteem and a more external locus of control. However, it has also been suggested that COAs are more resilient than previous studies have indicated (Werner, 1986). (Berkowitz & Perkins, 1988)

Juan also stated, these issues also damaged his self-esteem. Juan felt he really didn’t have access to a normal childhood and never really developed any friendship bonds. Juan stated he joined a gang (The Latin Kings) to develop a secure family and friendship bonds.

The desire to control their environment and the need for external structure were identified as additional conduits to gang affiliation. Many young teens were already tangentially involved with gangs by the age of nine or ten because of gang presence in the community. However, when they experienced changes in family structure and were denied involvement with their father, or father-figure, they increased their commitment and involvement with older gang members. Additionally, some of the boys had even had to assume the role of family protector and father figure at home and cope with all the pressures these roles imply. (Bracki, Dolson, & Maurice, 1997)

Juan’s childhood hindered him to make positive decisions that would affect his future. Even though Juan had a positive bond with his mother, it still wasn’t enough. Juan mother had a permissive parenting style with Juan. Teyber and McClure (2011) states permissive parenting style is showing lots of warmth and emotions to the infant/child, but not being able to discipline the infant/child. (Page243) Juan’s relationship with his father did not exist; his father was either at work or drinking. Juan’s father had a disengaged parenting style with Juan. Teyber and McClure (2011) states disengaged parenting as having low control and low affection. (Page246) Juan didn’t have the positive male role model in his immediate family. Juan turned to the gang to receive the male role model he needed.

Juan appeared to be open and honest in our sessions. Juan seemed to want to take charge in the session. After hearing Juan’s history, Juan was used to taking charge of a situation and doing things on his own. After a couple of sessions Juan seemed to feel comfortable with me and we started to develop a therapeutic alliance. Juan appeared to be a caretaker, big brother and parent to the other residents at Integrity House. Juan also demonstrated compassion and understanding. When Juan was upset he would isolate, so he would not demonstrate a behavior out of his character. Juan was well liked and the residents admired and respected him for the way he carried himself. Juan appears to be dealing with preoccupied attachment style.

Juan’s goals:

- To learn to cope with automatic thoughts (cognitive distortions).

- To develop a relapse prevention plan.

Juan’s objectives:

- Attend individual and group counseling sessions. Individual counseling 2x per week and group counseling 4x daily.

- Write positive affirmations at least 1x per week.

- Seek NA meetings to attend to seek a home group and a sponsor, seek one stop career center and other job related agencies to seek employment.

Part 3: Psychodynamic Intervention

The holding environment is based on the therapeutic alliance between the client and the therapist. The type of therapeutic relationship that develops is based on the type of relationship the client had with his mother or caretaker. If the child had a secure attachment, the bond between the therapist and client is easily developed. If the client had an unsecure attachment the therapeutic relationship will be difficult to develop. The therapist will have to gain the client’s trust to develop this bond. Theories used to underlie this intervention are: cognitive behavioral theory, objective relations theory and attachment theory. Teyber and McClure (2011) stated cognitive behavioral theory is challenging the negative thoughts about self and the environment to change unhealthy behavior. (page16) Teyber and McClure (2011) stated objective relations theory is defined as the way a person deals with other and/or situations is based on their relationship as an infant. (page10) Teyber and McClure (2011) stated attachment theory as the relationship between the parent/caretaker during infancy and how that relationship affects their adult relationships. (page11) The holding environment is crucial because Juan’s past stated