Case study 1 : Daniella
Daniella, is a sixty year old woman, attends the emergency department complaining of numbness and tingling in her legs. She has presented three times in the past two months with the same symptoms. Each time she has seen a different doctor, and a variety of investigations have been conducted with no clear cause of her symptoms identified. Daniella does have a history of type 2 diabetes and heart disease. On this visit to the emergency department she is accompanied by her husband and daughter. While Daniella speaks English well, when she is stressed her comprehension seems to diminish and she misunderstands what is said to her. The physical examination, on this occasion as before, is normal, and her diabetes and heart disease appear well controlled.
Daniella migrated to Australia from Italy when she was twenty-two years old. She met her husband, who had been born in Australia to Italian parents, shortly after she arrived, and they married twelve months later. They have four children, all of whom have left home, although only her eldest daughter is married. There are no grandchildren. She says that their marriage is happy. She frequently comments on the marital status of her children and the lack of grandchildren, and wonders if she has been a bad mother. Her husband has recently retired, and she finds it stressful to have him around the house all the time. She has a small number of close friends, but has been finding it difficult to leave the house and visit with them, feeling a responsibility for looking after her husband while he is at home. Daniella is very worried about the tingling and numbness in her legs, and feels that the doctors have not been listening to her. She usually attends a large general practice clinic close to her home for the monitoring of her diabetes and heart disease, where she sees a different doctor each time she attends. The medical registrar after discussing Daniella’s symptoms with the medical team, come to the conclusion that they are likely to be stress related, either due to the mechanism of a conversion disorder (neurological symptoms in the presence of a psycho-social stressor), or as symptoms of anxiety associated with hyperventilation. The symptoms have both a symbolic and real effect of getting her out of the house and receiving care. Little is known about Daniella’s family of origin at this stage, and a reminder note is made to enquire about this, as this may help to understand the fears and disappointments that Daniella is experiencing associated with her children leaving home and her husband retiring.
Case study 2 Akbar
Akbar is a thirty-five year old Somalian man who visits his GP because he is finding it difficult to leave his home. Akbar is concerned that he has become fearful of leaving his home, experiencing a sense of dread that something terrible will happen. His heart races and he often becomes dizzy. On one occasion he collapsed while he was at the mosque, and consequently has stopped attending services. He describes himself as a ‘nervous person’ but says it has got much worse over the past two years. He is concerned that he will lose his employment benefits because he has stopped attending job interviews. He has very few friends, and spends his days mainly reading and looking after his elderly parents, with whom he lives. Akbar immigrated to Australia when he was seventeen. His family had been persecuted in Somalia, and he escaped to Pakistan before immigrating to Australia. He has many relatives still living in Somalia, and he worries about their safety. He completed an electrical apprenticeship, but has not worked as an electrician since injuring himself at work five years ago. Akbar separated from his wife shortly after his accident, and has no children.
Case study 3 Emily
Emily is an eighteen year old woman who recently graduated from high school. Emily was born in Whyalla. Her father is an Aboriginal Australian and is an electrician. Her mother is of Anglo-Saxon ancestry and is a Nurse. Emily was shy in her childhood, however, she reports that her home life was ‘happy’ most of the time. However, Emily also says that she was constantly teased by her school mates during her school life about being of mixed race, and always believed that she was ‘unattractive’. Emily was always very close to her family during her primary schooling. When Emily was 13, she moved with her family to Adelaide and settled in the inner western suburbs. She attended the local high school. Academically, she was doing very well and was outspoken at her new high school and was elected as a student representative. However, as she started to receive attention from boys, she described feeling extreme anxiety about how to handle their sexual advances. When at high school, Emily never invited friends over to her house because she was not comfortable by her mixed racial heritage. Emily suggests she had issues with not being ‘black’ or ‘white’. During most of high school, Emily dated Graham. Graham and Emily broke up as she finished high school because he wanted to be free to date other girls. Emily has been a member of a debating club for some time, but more recently she is not happy, she agitates and gets angry easily and not enjoying herself. Emily is working in a bar but does not like her current job; however, she is not motivated to look for other work. She describes feeling “on the edge” when she is getting ready for work or for her debating club and is starting to use all sorts of excuses to avoid going to either of them. She has recently lost all interest in cleaning her apartment, has lost interest in eating and is paying less attention to her
personal appearance. Emily is now avoiding seeing her parents and her brother. About two months ago, Emily became friendly with a patron of the bar where she works. After a lengthy conversation, he encouraged Emily to seek professional help and support from a social worker at a community health centre – this is you.
Choose only one of the above Case Studies and address all the following questions:
1. Identify at least 2 developmental theories and discuss what (physical, social and cognitive) developmental issues have contributed to the life situation of the client in your chosen case study? You need to provide reasons why you selected these theories.
2. What stress symptoms (Physical, Psychological, Behavioural) can you identify for your chosen client?
3. What strategies/techniques you would suggest to your client for managing and improving their stressful life situation? Explain why you have recommended these strategies